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General NPI Number Information
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NPI Number | 1316733298
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Entity Type | Individual
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Provider Name | KENPRIL KENISE ELLIS
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Gender | Female
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 194 AINSDALE DR
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City | RICHMOND HILL
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State | GA
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Zip | 31324-7821
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Country | US
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Telephone | 607-621-5676
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Fax |
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Provider Business Mailing Address
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Address Line | 12008 MIDDLEGROUND RD APT R7
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City | SAVANNAH
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State | GA
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Zip | 31419-3637
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Country | US
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Telephone | 478-335-4813
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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