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General NPI Number Information
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NPI Number | 1073324232
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Entity Type | Organization
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Legal Business Name | MARY ELLINGTON APRN LLC
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 1871 US HIGHWAY 41AS
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City | DIXON
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State | KY
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Zip | 42409-9448
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Country | US
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Telephone | 270-543-6372
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Fax | 270-440-0007
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Provider Business Mailing Address
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Address Line | 1870 SHAKERAG RD
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City | HANSON
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State | KY
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Zip | 42413-9698
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Country | US
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Telephone | 270-543-6372
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Fax | 270-440-0007
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Authorized Official
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Title or Position | OWNER
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Name | MARY VIRGINIA ELLINGTON
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Credential | APRN
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Telephone | 270-543-6372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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