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General NPI Number Information
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NPI Number | 1376377077
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Entity Type | Individual
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Provider Name | EMILY JEANNENE ELLIS FNP
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Gender | Female
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Dates
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Enumeration Date | 08/27/2024
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 10201 HIGHWAY 16
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City | COMANCHE
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State | TX
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Zip | 76442-4462
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Country | US
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Telephone | 254-879-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 350 COUNTY ROAD 132
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City | COMANCHE
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State | TX
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Zip | 76442-4496
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Country | US
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Telephone | 575-644-8510
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1167481
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License Number State | TX
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