Provider Demographics
NPI:1205886827
Name:ELLIS, APRIL TAMARA (PA)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:TAMARA
Last Name:ELLIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:APRIL
Other - Middle Name:TAMARA
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4009 CADES CV
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-8501
Mailing Address - Country:US
Mailing Address - Phone:139-683-8365
Mailing Address - Fax:
Practice Address - Street 1:4009 CADES CV
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-8501
Practice Address - Country:US
Practice Address - Phone:913-683-8365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005041220363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical