Healthcare Provider Details

I. General information

NPI: 1467039446
Provider Name (Legal Business Name): KIMBERLEE MARIE ELLISON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLEE MARIE HEAD

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 CENTURY PL SE
HICKORY NC
28602-4031
US

IV. Provider business mailing address

1100 TUNNEL RD
ASHEVILLE NC
28805-2043
US

V. Phone/Fax

Practice location:
  • Phone: 828-431-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number171645
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: