Provider Demographics
NPI:1437868411
Name:ELLIS, KAITLYNN
Entity Type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 NALL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1244
Mailing Address - Country:US
Mailing Address - Phone:913-338-5585
Mailing Address - Fax:913-338-3228
Practice Address - Street 1:10701 NALL AVE STE 100
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1244
Practice Address - Country:US
Practice Address - Phone:913-338-5585
Practice Address - Fax:913-338-3228
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant