Healthcare Provider Details

I. General information

NPI: 1750997318
Provider Name (Legal Business Name): SARA J ELLIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 GLENWOOD ST
CEDAR BLUFF VA
24609-9440
US

IV. Provider business mailing address

660 STAR ST
POUNDING MILL VA
24637-4309
US

V. Phone/Fax

Practice location:
  • Phone: 276-596-9181
  • Fax: 276-596-9182
Mailing address:
  • Phone: 276-202-8995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024180178
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: