Healthcare Provider Details

I. General information

NPI: 1881526648
Provider Name (Legal Business Name): ASHLEY ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 JEFFERSON DAVIS BLVD
NATCHEZ MS
39120-5107
US

IV. Provider business mailing address

627 HIGHWAY 61 N
NATCHEZ MS
39120-8407
US

V. Phone/Fax

Practice location:
  • Phone: 601-492-4001
  • Fax:
Mailing address:
  • Phone: 601-492-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: