Individual
CHANDRA ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
716 MUD LAKE TRL, FORT WORTH, TX 76120-2037
(682) 564-2588
Mailing address
716 MUD LAKE TRL, FORT WORTH, TX 76120-2037
(682) 564-2588
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
644695
TX
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/14/2021
Last updated
07/01/2021
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