Healthcare Provider Details

I. General information

NPI: 1568002038
Provider Name (Legal Business Name): KAITLYN ELLERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WASHINGTON RD
WEST POINT NY
10996-1109
US

IV. Provider business mailing address

43 WOODBURY RD
HIGHLAND MILLS NY
10930-2406
US

V. Phone/Fax

Practice location:
  • Phone: 845-938-1352
  • Fax:
Mailing address:
  • Phone: 845-570-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number309505
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: