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NPI Code Detail

MEDICARE: SARA J ELLIS FNP-C

MEDICARE: SARA J ELLIS FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner0024180178VA

General Provider Information

NPI Number : 1750997318
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA J ELLIS FNP-C
Provider Business Mailing Address
First Line : 660 STAR ST
Second Line :
City : POUNDING MILL
State : VA
Zip : 24637-4309
Country : US
Telephone Number : 276-202-8995
Fax Number :
Provider Business Practice Location Address
First Line : 128 GLENWOOD ST
Second Line :
City : CEDAR BLUFF
State : VA
Zip : 24609-9440
Country : US
Telephone Number : 276-596-9181
Fax Number : 276-596-9182
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2020
Last Update Date : 06/24/2026

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