Healthcare Provider Details

I. General information

NPI: 1144165176
Provider Name (Legal Business Name): KHI ELLISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 W 6TH AVE
PINE BLUFF AR
71601-4031
US

IV. Provider business mailing address

813 W 6TH AVE
PINE BLUFF AR
71601-4031
US

V. Phone/Fax

Practice location:
  • Phone: 501-618-6380
  • Fax: 870-532-8240
Mailing address:
  • Phone: 501-618-6380
  • Fax: 870-532-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: