KENNETH RAY ELLIS (NPI# 1700103934) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700103934 |
| Entity Type | Individual |
| Full Name | KENNETH RAY ELLIS |
| Credential | MA |
| Practice Address |
2243 Eddie Williams Rd Johnson City TN 37601-2872 |
| Mailing Address |
1167 Spratlin Park Dr Gray TN 37615-6205 |
| Practice Telephone | 4239285627 |
| Practice Fax Number | 4234673644 |
| Mailing Telephone | 4234673600 |
| Mailing Fax Number | 4234673644 |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2010-04-28 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154403210 | Kenneth Nickolas Ellis | Dentist | 7995 Bellfort St, Houston, TX 77061-1960 | 2006-10-19 |
| 1417973850 | Kenneth J Ellis | Psychologist | 1106 Columbia Ave, Suite 100, Marysville, WA 98270-4335 | 2006-07-15 |
| 1215981022 | Kenneth R Ellis | Ophthalmology | 1213 24th St, Suite 300, Anacortes, WA 98221-2592 | 2006-05-19 |
| 1447248133 | Kenneth Ellis | Anesthesiology | 1099 Augusta Falls Way, Naples, FL 34119-1362 | 2005-10-07 |
| 1992212633 | Kenneth Ellis | Case Manager/Care Coordinator | 1802 Hwy 82 West, Crossett, AR 71635 | 2018-01-03 |
| 1215017694 | Kenneth R Ellis | Psychologist | 5525 Twin Knolls Rd, Suite 327, Columbia, MD 21045-3266 | 2006-10-17 |
| 1114902228 | Kenneth K Ellis | Internal Medicine | 11111 Research Blvd, Suite 390, Austin, TX 78759-5264 | 2005-12-12 |
| Street Address |
2243 EDDIE WILLIAMS RD |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37601-2872 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730245010 | Frontier Health | Clinic/Center | 2243 Eddie Williams Rd, Johnson City, TN 37601-2872 | 2006-12-29 |
| 1730685504 | Cristi Lynn Blalock | Counselor | 2243 Eddie Williams Rd, Johnson City, TN 37601-2872 | 2018-04-02 |
| 1396177010 | Shounda Michelle Stevenson | Case Manager/Care Coordinator | 2243 Eddie Williams Rd, Johnson City, TN 37601-2872 | 2013-08-05 |
| 1427492842 | Megan Brooke Clark | Counselor | 2243 Eddie Williams Rd, Johnson City, TN 37601-2872 | 2013-04-29 |
| 1750628293 | Teresa Diane Godsey | Case Manager/Care Coordinator | 2243 Eddie Williams Rd, Johnson City, TN 37601-2872 | 2013-01-03 |
| 1780948034 | Lacinda Thomas Hartman | Counselor | 2243 Eddie Williams Rd, Johnson City, TN 37601-2872 | 2012-07-02 |
| 1336407154 | Aaron Jordan Cox | Counselor | 2243 Eddie Williams Rd, Johnson City, TN 37601-2872 | 2012-04-30 |
| 1457638215 | Karen S Barrett | Counselor | 2243 Eddie Williams Rd, Johnson City, TN 37601-2872 | 2011-11-08 |
| 1154621498 | Candi Michelle Doulgas | Counselor | 2243 Eddie Williams Rd, Johnson City, TN 37601-2872 | 2010-11-02 |
| 1184957177 | Kevin Lynn Thompson | Case Manager/Care Coordinator | 2243 Eddie Williams Rd, Johnson City, TN 37601-2872 | 2009-09-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396381992 | Juan Carlos Simon Villegas Gomez | Specialist/Technologist | 1081 John Robert Bell Dr, Johnson City, TN 37601 | 2019-11-19 |
| 1629537279 | Jaima Suzanne Price | Hearing Instrument Specialist | 106 E Watauga Avenue, Johnson City, TN 37601 | 2019-03-13 |
| 1275004467 | Brittany Howell | Speech-Language Pathologist | 2114 E. Fairview Ave, Johnson City, TN 37601 | 2018-12-16 |
| 1194229948 | Heather Chantel Lester | Physical Therapist | 2114 E. Fairview Avenue, Johnson City, TN 37601 | 2018-03-19 |
| 1477061869 | Patrick Conway Reynolds | Specialist/Technologist | 1081 John Robert Bell Drive, Johnson City, TN 37601 | 2018-01-19 |
| 1790201135 | Surgical Services of East Tennessee PC | Surgery | 300 East Main St., Suite 301, Johnson City, TN 37601 | 2017-08-17 |
| 1073065694 | Davina Leah Reppond | Home Health | 1204 E Myrtle Ave, Johnsoncity, TN 37601 | 2016-10-31 |
| 1003365503 | Wendi Y Minutolo | Behavioral Analyst | 403 Princeton Rd Ste 3, Johnson City, TN 37601 | 2016-09-25 |
| 1306208798 | Rachel Anne Anderson | Nurse Practitioner | 1118 East Holston Avenue, Johnson City, TN 37601 | 2016-03-24 |
| 1932560976 | Kaydee Louise Davidson | Occupational Therapist | 3209 Bristol Highway, Johnson City, TN 37601 | 2016-03-18 |
| Find all providers in zip 37601 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144620881 | Jennifer Spalik | Specialist | 167 N Hudson St, Johnson City, NY 13790-1414 | 2014-08-29 |
| 1417128968 | The Michal Child Development Center | Specialist | 302 Wesley St Ste 10, Johnson City, TN 37601-1769 | 2008-03-12 |
| 1922278480 | Mountainview Oral & Maxillofacial Surgery, P.C. | Specialist | 535 Columbia Dr, Johnson City, NY 13790-3302 | 2008-03-11 |
| 1346390937 | East Tennessee Anesthesia Services. LLC | Specialist | 221 Shadowood Dr, Johnson City, TN 37604-1128 | 2007-01-12 |
| 1962429647 | Tri-state Cardiology | Specialist | 2408 Susannah St, Ste.1, Johnson City, TN 37601-1728 | 2006-07-17 |
| 1366476657 | Gauri K Bhardwaj | Specialist | 699 Main St, Johnson City, NY 13790-1743 | 2006-07-10 |
| 1235168949 | Gamal S Boutros | Specialist | 329 Wesley Street, Suite 1, Johnson City, TN 37601-1721 | 2006-07-03 |
| 1740216910 | Daniel M O'roark | Specialist | 701 N State of Franklin Rd, Ste 9, Johnson City, TN 37604-3645 | 2006-06-22 |
| 1336135011 | Mohamad Isam Abdelazim | Specialist | 700 Harry L Dr, Johnson City, NY 13790-1145 | 2005-09-27 |
| 1922009521 | Elizabeth C. Smith | Specialist | 302 Wesley St, Suite 10, Johnson City, TN 37601-1740 | 2005-08-03 |
| Find all providers in JOHNSON CITY | ||||
| City | JOHNSON CITY |
| Zip Code | 37601 |
Please comment or provide details below to improve the information on KENNETH RAY 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.