Healthcare Provider Details

I. General information

NPI: 1649700063
Provider Name (Legal Business Name): LEIGH ANN ELLIS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 N MONTVIEW DR
FAYETTEVILLE AR
72701-2867
US

IV. Provider business mailing address

1327 N MONTVIEW DR
FAYETTEVILLE AR
72701-2867
US

V. Phone/Fax

Practice location:
  • Phone: 206-245-0526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberA005177
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR005177
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: