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Individual

DR. CAROLYN ANN ELLSWORTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
312 N KENTUCKY ST, WEST PLAINS, MO 65775-2073
(417) 257-7076
(417) 257-1417
Mailing address
312 N KENTUCKY ST, WEST PLAINS, MO 65775-2073
(417) 257-7076
(417) 257-1417

Taxonomy

Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
102421
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
123942001
AK
05
203592001
MO
Enumeration date
07/06/2005
Last updated
11/01/2011
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