Individual
KENNETH ROBERT ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1032 MAR WALT DR, SUITE 250, FORT WALTON BEACH, FL 32547-6661
(850) 863-3463
(850) 315-6051
Mailing address
1032 MAR WALT DR, SUITE 250, FORT WALTON BEACH, FL 32547-6661
(850) 863-3463
(850) 315-6051
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
9106823
FL
Other
Enumeration date
07/10/2006
Last updated
01/14/2022
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