Individual
MRS. KIM MARIE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
302 UNIVERSITY PKWY, AIKEN, SC 29801-6302
(803) 641-5883
Mailing address
PO BOX 530062, ATLANTA, GA 30353-0062
(843) 695-6071
(843) 569-5879
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN 20053 RX
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP3758
—
SC
Enumeration date
03/10/2016
Last updated
07/06/2021
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