Healthcare Provider Details

I. General information

NPI: 1801785688
Provider Name (Legal Business Name): KELSEY M ELLIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY M WALLER

II. Dates (important events)

Enumeration Date: 06/28/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 AMHERST AVE
MANHATTAN KS
66503-3043
US

IV. Provider business mailing address

200 RESEARCH DR
MANHATTAN KS
66503-3049
US

V. Phone/Fax

Practice location:
  • Phone: 785-539-8700
  • Fax: 855-564-1025
Mailing address:
  • Phone: 785-539-4644
  • Fax: 785-539-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-84517
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: