Individual
KAITLYN ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2561 PASS RD STE D, BILOXI, MS 39531-2712
(228) 400-0098
Mailing address
11616 TALLA DR, OCEAN SPRINGS, MS 39564-7808
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
905766
MS
Other
Enumeration date
02/12/2024
Last updated
02/12/2024
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