KELLEY D ELLIS (NPI# 1073622858) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073622858 |
| Entity Type | Individual |
| Full Name | KELLEY D ELLIS |
| Credential | RNFA, CNOR |
| Practice Address |
1900 Mistletoe Blvd Ste 200 Fort Worth TX 76104-4049 |
| Practice Telephone | 8178785333 |
| Practice Fax Number | 8178785334 |
| Mailing Telephone | 8178785333 |
| Mailing Fax Number | 8178785334 |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2019-02-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WM0705X |
Registered Nurse Specialization: Medical-Surgical |
551667 | TX | Nursing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | CIGNA | 0672032 | 01 |
| TX | BCBS OF TX | 89N921 | 01 |
| TX | AETNA | 7521427 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790322576 | Kelley Ellis | Nurse Practitioner | 225 E Chicago Ave # 22, Chicago, IL 60611-2991 | 2019-11-29 |
| Street Address |
1900 MISTLETOE BLVD STE 200 |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76104-4049 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891735684 | Samir B Lapsiwala | Neurological Surgery | 1900 Mistletoe Blvd Ste 200, Fort Worth, TX 76104-4049 | 2006-06-08 |
| 1912411562 | Jenna Leigh Anderson | Physician Assistant | 1900 Mistletoe Blvd Ste 200, Fort Worth, TX 76104-4049 | 2017-11-17 |
| 1881072593 | Kristi Mosley | Nurse Practitioner | 1900 Mistletoe Blvd Ste 200, Fort Worth, TX 76104-4049 | 2015-05-13 |
| 1619302338 | Christopher G Hayes | Nurse Practitioner | 1900 Mistletoe Blvd Ste 200, Fort Worth, TX 76104 | 2013-09-12 |
| 1912248527 | Vaquero Medical | Specialist/Technologist, Other | 1900 Mistletoe Blvd Ste 200, Fort Worth, TX 76104-4014 | 2013-03-06 |
| 1982963591 | Grant A. Booher | Neurological Surgery | 1900 Mistletoe Blvd Ste 200, Fort Worth, TX 76104-4049 | 2012-05-16 |
| 1912284951 | Amanda N Evans | Nurse Practitioner | 1900 Mistletoe Blvd Ste 200, Fort Worth, TX 76104-4049 | 2011-11-04 |
| 1598942609 | Anthony W. Lee | Neurological Surgery | 1900 Mistletoe Blvd Ste 200, Fort Worth, TX 76104-4049 | 2008-01-31 |
| 1467488288 | Brent T Alford | Neurological Surgery | 1900 Mistletoe Blvd Ste 200, Fort Worth, TX 76104-4049 | 2006-06-23 |
| 1629004445 | Thomas S Ellis | Neurological Surgery | 1900 Mistletoe Blvd Ste 200, Fort Worth, TX 76104 | 2006-06-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669082186 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 1115 8th St, Fort Worth, TX 76104 | 2020-08-10 |
| 1992343693 | Iris Giove | Psychologist | John Peter Smith Hospital, 1500 S. Main St., Fort Worth, TX 76104 | 2019-12-13 |
| 1104480656 | Swarnalaxmi Umapathy | Student in an Organized Health Care Education/Training Program | 900 8th Avenue, Fort Worth, TX 76104 | 2019-04-30 |
| 1881189132 | Mega Surgical Assistants LLC | Specialist/Technologist, Other | 1301pennsylvania, Fort Worth, TX 76104 | 2018-06-28 |
| 1356848899 | Tricia Kelly | Nurse Practitioner | 1325 Pennsylvania Avenue Suite 560, Fort Worth, TX 76104 | 2018-04-11 |
| 1952820979 | Modern Vein Clinic | Internal Medicine | 757 8th Avenue, Suite A, Forth Worth, TX 76104 | 2017-09-11 |
| 1790207165 | Vanessa Abbood | Dietitian, Registered | 900 Eighth Ave, Fns Department, Fort Worth, TX 76104 | 2017-07-07 |
| 1922537562 | Nicole Marie Tod | Student in an Organized Health Care Education/Training Program | 1500 S Main Street, Fort Worth, TX 76104 | 2017-06-07 |
| 1770025934 | Micah Bonola | Chiropractor | 1300 W. Rosedale St, Ste. A, Fort Worth, TX 76104 | 2016-11-04 |
| 1518315894 | United Bioscience, LLC. | Clinical Medical Laboratory | 901 W. Leuda St., B, Fort Worth, TX 76104 | 2016-05-27 |
| Find all providers in zip 76104 | ||||
| Taxonomy Code | 163WM0705X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Medical-Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053690826 | Christi Brock Stephens | Registered Nurse | 3809 Collinwood Ave, Fort Worth, TX 76107-4540 | 2011-08-11 |
| 1225091879 | Leslie Marie Phillips | Registered Nurse | 10017 Stoneleigh Dr, Fort Worth, TX 76126 | 2006-04-06 |
| 1154576197 | Tawanda Nitchelle Bostic | Registered Nurse | 6000 Western Pl, Fort Worth, TX 76107-4607 | 2008-11-18 |
| 1689862120 | Christopher P. Talabock | Registered Nurse | 800 5th Ave, Suite 500, Fort Worth, TX 76104-7300 | 2007-10-10 |
| 1679689319 | Kimberly Jean Shearer | Registered Nurse | 1325 Pennsylvania Ave, Suite 890, Fort Worth, TX 76104-2158 | 2006-08-23 |
| 1639101512 | Ricky Tekell | Registered Nurse | 3863 Sw Loop 820, Suite 300, Fort Worth, TX 76133-2064 | 2006-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760098321 | Sundra Davis | Registered Nurse | 9014 Japonica Dr, Rosenberg, TX 77469-2372 | 2020-09-18 |
| 1760090237 | Jarcolla Osagie | Registered Nurse | 8329 Ariel St, Houston, TX 77074-2802 | 2020-07-21 |
| 1831707033 | Laura R Megonigal | Registered Nurse | 3830 Arbor Grove Trl, Midlothian, TX 76065-2450 | 2020-07-14 |
| 1912538620 | Susan Touchstone | Registered Nurse | 3024 Hughes Rd, Dickinson, TX 77539-7540 | 2020-01-31 |
| 1679103139 | Chelsea Moorhead | Registered Nurse | 18506 Gunda Heights Dr, Cypress, TX 77433-5068 | 2020-01-23 |
| 1457997439 | Beenish Hooda | Registered Nurse | 330 E Polk St Apt 405, Richardson, TX 75081-4175 | 2019-11-25 |
| 1861037798 | Naty Jane Demonteverde Shackelford | Registered Nurse | 13409 Georgia Hollow Court, Rosharon, TX 77583-2278 | 2019-11-14 |
| 1922659986 | Monique Nsoedo | Registered Nurse | 19839 Youpon Leaf Way, Houston, TX 77084-3385 | 2019-09-21 |
| 1982253415 | Lauren E Reyes | Registered Nurse | 6 N Wilde Yaupon, Spring, TX 77381-4506 | 2019-09-07 |
| 1629627286 | Afanwi Mbonchom | Registered Nurse | 7519 Eastwood Lake Ln, Richmond, TX 77407-2878 | 2019-09-06 |
| Find all providers with the same taxonomy | ||||
| City | FORT WORTH |
| Zip Code | 76104 |
Please comment or provide details below to improve the information on KELLEY D ELLIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.