Individual
DANNY ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2100 HIGHWAY 61 N, VICKSBURG, MS 39183-8211
(601) 883-4250
Mailing address
2100 HIGHWAY 61 N, VICKSBURG, MS 39183-8211
(601) 883-4250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R826981
MS
363LG0600X
Gerontology Nurse Practitioner
R826981
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00634567
—
MS
05
—
1029611
—
LA
Enumeration date
05/17/2007
Last updated
08/12/2008
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