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NPI Code Detail

MEDICARE: MRS. KELLY ELIZABETH ELLIS APN, CNM

MEDICARE: MRS. KELLY ELIZABETH ELLIS APN, CNM
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
1367A00000XAdvanced Practice Midwife209008508IL
2367A00000XAdvanced Practice Midwife

General Provider Information

NPI Number : 1962705103
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY ELIZABETH ELLIS APN, CNM
Provider Business Mailing Address
First Line : 5000 E MAIN ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43213-2440
Country : US
Telephone Number : 614-235-5555
Fax Number : 614-536-1994
Provider Business Practice Location Address
First Line : 5000 E MAIN ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43213-2440
Country : US
Telephone Number : 614-235-5555
Fax Number : 614-536-1994
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2010
Last Update Date : 12/15/2025

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