Healthcare Provider Details

I. General information

NPI: 1881447696
Provider Name (Legal Business Name): JESSICA CAITLIN ELLZEY APRN, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA CAITLIN WILLIS

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST FL 4
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

678 SHERIDAN DR
LEXINGTON KY
40503-1726
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-0921
  • Fax: 859-257-1831
Mailing address:
  • Phone: 502-403-7446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1152126
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number4023701
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: