MEDICARE: KAYCIE DOUSHARM ELLERBE RN

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
1	163W00000X	Registered Nurse	RN277661	GA

General Provider Information

NPI Number	:	1992664718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYCIE DOUSHARM ELLERBE RN

Provider Business Mailing Address
First Line	:	5679 CLYATTVILLE LAKE PARK RD
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31601-0867
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 S 6TH ST STE 9
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-4643
Country	:	US
Telephone Number	:	888-227-3552
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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