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General NPI Number Information
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NPI Number | 1992664718
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Entity Type | Individual
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Provider Name | KAYCIE DOUSHARM ELLERBE RN
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Gender | Female
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Dates
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Enumeration Date | 01/19/2026
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 225 S 6TH ST STE 9
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City | MINNEAPOLIS
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State | MN
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Zip | 55402-4643
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Country | US
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Telephone | 888-227-3552
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Fax |
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Provider Business Mailing Address
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Address Line | 5679 CLYATTVILLE LAKE PARK RD
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City | VALDOSTA
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State | GA
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Zip | 31601-0867
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN277661
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License Number State | GA
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