Provider Demographics
NPI:1780086710
Name:DART, ELLISON BETH (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ELLISON
Middle Name:BETH
Last Name:DART
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2885 OLD US 70 HWY W LOT 33
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-6562
Mailing Address - Country:US
Mailing Address - Phone:919-817-3373
Mailing Address - Fax:
Practice Address - Street 1:10027 US 70 BUSINESS HWY W STE C
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2115
Practice Address - Country:US
Practice Address - Phone:919-424-0062
Practice Address - Fax:919-704-3674
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014036363LP0808X
NC228772163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency