Provider Demographics
NPI:1669167557
Name:METZGER, ELLIE (FNP-C)
Entity type:Individual
Prefix:
First Name:ELLIE
Middle Name:
Last Name:METZGER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3204
Mailing Address - Country:US
Mailing Address - Phone:513-473-0128
Mailing Address - Fax:
Practice Address - Street 1:3300 KEMP RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-4200
Practice Address - Country:US
Practice Address - Phone:614-776-0632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYF03220460363LF0000X
OHAPRN.CNP.0031778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily