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NPI Code Detail

MEDICARE: KIERSTAN ELLIS

MEDICARE: KIERSTAN ELLIS
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
1104100000XSocial Worker17984SC

General Provider Information

NPI Number : 1821972894
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIERSTAN ELLIS
Provider Business Mailing Address
First Line : PO BOX 748465
Second Line :
City : ATLANTA
State : GA
Zip : 30374-8465
Country : US
Telephone Number : 855-284-7483
Fax Number : 617-807-0958
Provider Business Practice Location Address
First Line : 4975 LACROSS RD STE 351
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-6530
Country : US
Telephone Number : 803-403-0294
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2025
Last Update Date : 08/04/2025

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Directions to “ KIERSTAN ELLIS ” Practice Location

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