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Kelly Anne Ellison
Acute Care Nurse Practitioner in Southlake, Texas
NPI 1265823843

Kelly Anne Ellison is an Acute Care Nurse Practitioner based in Southlake, TX and is specialized in Acute Care. Kelly Anne Ellison practices in Southlake, TX. The NPI Number for Kelly Anne Ellison is 1265823843 and holds a License No. AP127337 (Texas).

The current practice location address for Kelly Anne Ellison is 125 Davis Blvd, Southlake, TX and can be reached out via phone at 682-212-9104.

Location: 125 Davis Blvd, Southlake, TX, 76092-8209
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1265823843
Provider Name
Kelly Anne Ellison
Credential
Provider Entity Type
Individual
Gender
Female
Address
125 Davis Blvd, Southlake, TX, 76092-8209
Phone Number
682-212-9104
Fax Number
Provider Enumeration Date
02/18/2015
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
PENDING 05 TX
PENDING 01 TX BCBS
institution
Provider Business Practice Location Address Details
Address
125 Davis Blvd
City
Southlake
State
Texas
Zip
76092-8209
Phone Number
682-212-9104
Fax Number
person
Provider Business Mailing Address Details
Address
125 Davis Blvd
City
Southlake
State
Texas
Zip
76092-8209
Phone Number
682-212-9104
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Acute Care
Taxonomy
363LA2100X
License No.
AP127337 (Texas)
Definition
Definition to come...
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