Individual
KASEY DAKOTA BLUE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1340 HAL GREER BLVD, HUNTINGTON, WV 25701-3804
(304) 526-2000
Mailing address
1985 MCVEIGH AVE, HUNTINGTON, WV 25701-4219
(304) 654-7004
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
90998
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
106823
WV
Other
Enumeration date
04/23/2020
Last updated
06/29/2020
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