Provider Demographics
NPI:1235890195
Name:ELLIS DIABETES EDUCATION & CONSULTING, LLC.
Entity Type:Organization
Organization Name:ELLIS DIABETES EDUCATION & CONSULTING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C, CDCES
Authorized Official - Phone:817-908-5519
Mailing Address - Street 1:707 CAROLYN T. HILL DR.
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104
Mailing Address - Country:US
Mailing Address - Phone:817-908-5519
Mailing Address - Fax:
Practice Address - Street 1:707 CAROLYN T. HILL DR.
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-7510
Practice Address - Country:US
Practice Address - Phone:817-908-5519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty