MEDICARE: ANTHONETTA ELLISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1578420808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONETTA ELLISON

Provider Business Mailing Address
First Line	:	622 HEATHER TRL APT 1105
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-3759
Country	:	US
Telephone Number	:	214-397-7002
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 HEATHER TRL APT 1105
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-3759
Country	:	US
Telephone Number	:	214-397-7002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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Directions to “ ANTHONETTA ELLISON ” Practice Location

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