Provider Demographics
NPI:1093407371
Name:ELLIS, JOHN STEVEN JR (FNP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STEVEN
Last Name:ELLIS
Suffix:JR
Gender:M
Credentials:FNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8911 N CAPITAL OF TEXAS HWY STE 1110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13835 BOREN ST
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6476
Practice Address - Country:US
Practice Address - Phone:704-912-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF05230248363LF0000X
NC5018142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily