Provider Demographics
NPI:1801785688
Name:ELLIS, KELSEY M (APRN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:M
Last Name:ELLIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:M
Other - Last Name:WALLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 RESEARCH DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-3049
Mailing Address - Country:US
Mailing Address - Phone:785-539-4644
Mailing Address - Fax:785-539-8010
Practice Address - Street 1:2900 AMHERST AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-3043
Practice Address - Country:US
Practice Address - Phone:785-539-8700
Practice Address - Fax:855-564-1025
Is Sole Proprietor?:No
Enumeration Date:2025-06-28
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-84517363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care