Provider Demographics
NPI:1982213898
Name:ELLIS, ELIZABETH ALISON KNIGHT (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ALISON KNIGHT
Last Name:ELLIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ALISON
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 242848
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-2848
Mailing Address - Country:US
Mailing Address - Phone:334-834-1300
Mailing Address - Fax:
Practice Address - Street 1:1722 PINE ST STE 700
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1125
Practice Address - Country:US
Practice Address - Phone:334-834-1300
Practice Address - Fax:334-834-8347
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-114106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily