Healthcare Provider Details

I. General information

NPI: 1982213898
Provider Name (Legal Business Name): ELIZABETH ALISON KNIGHT ELLIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ALISON ELLIS

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 PINE ST STE 700
MONTGOMERY AL
36106-1125
US

IV. Provider business mailing address

PO BOX 242848
MONTGOMERY AL
36124-2848
US

V. Phone/Fax

Practice location:
  • Phone: 334-834-1300
  • Fax: 334-834-8347
Mailing address:
  • Phone: 334-834-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-114106
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: