=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740860824
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONTE ELLISON MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2021
-----------------------------------------------------
Last Update Date | 08/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 LAKEVIEW CIR
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70433-7512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-273-5868
-----------------------------------------------------
Fax | 985-273-5869
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7811 KEATS ST
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70126-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-813-4274
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 347749
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------