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General NPI Number Information
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NPI Number | 1699402693
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Entity Type | Individual
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Provider Name | TEYLOR N ELLIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/01/2022
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 5718 CRAWFORDSVILLE RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46224-3704
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Country | US
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Telephone | 317-240-5001
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Fax |
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Provider Business Mailing Address
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Address Line | 401 N SENATE AVE UNIT 419
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-1286
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Country | US
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Telephone | 317-752-8191
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 99114632A
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License Number State | IN
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