MEDICARE: DONNA A THOMAS ELLIS CFNP

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	363LF0000X	Family Nurse Practitioner	602612	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760550990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA A THOMAS ELLIS CFNP

Provider Business Mailing Address
First Line	:	PO BOX 321359
Second Line	:
City	:	FLOWOOD
State	:	MS
Zip	:	39232-1359
Country	:	US
Telephone Number	:	601-933-5417
Fax Number	:	601-936-1336

Provider Business Practice Location Address
First Line	:	1040 N FLOWOOD DR STE 100
Second Line	:
City	:	FLOWOOD
State	:	MS
Zip	:	39232-9789
Country	:	US
Telephone Number	:	601-933-5417
Fax Number	:

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	03/24/2022

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