Healthcare Provider Details

I. General information

NPI: 1790680734
Provider Name (Legal Business Name): SARAH ANN ELLIS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E BRADFORD PKWY BLDG B
SPRINGFIELD MO
65804-4264
US

IV. Provider business mailing address

201 PLUMTREE DR
OZARK MO
65721-6590
US

V. Phone/Fax

Practice location:
  • Phone: 417-893-7760
  • Fax:
Mailing address:
  • Phone: 417-893-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022042820
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: