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1821850447 NPI number — KELLY METTS ELLIS APRN

NPI Number: 1821850447
Health Care Provider/Practitioner: KELLY METTS ELLIS APRN

Information about “1821850447” NPI (KELLY METTS ELLIS APRN) exists in 1821850447 in HTML format HTML  |  1821850447 in plain Text format TXT  |  1821850447 in PDF (Portable Document Format) PDF  |  1821850447 in an XML format XML  formats.

NPI Number : 1821850447 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1821850447",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ELLIS",
    "FirstName": "KELLY",
    "MiddleName": "METTS",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "APRN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 23321",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEW YORK",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "10087-3321",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "843-792-3829",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "169 ASHLEY AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHARLESTON",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29425-8905",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "843-792-3829",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/29/2024",
    "LastUpdateDate": "11/20/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LX0106X",
          "TaxonomyName": "Occupational Health Nurse Practitioner",
          "LicenseNumber": "APN28247RX",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "28247",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "APN28247RX",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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