Provider Demographics
NPI:1801322474
Name:ELLIS, BETSY DELL (FNP)
Entity type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:DELL
Last Name:ELLIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 MCQUEEN SMITH RD N STE 105
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7263
Mailing Address - Country:US
Mailing Address - Phone:615-891-8944
Mailing Address - Fax:334-361-7656
Practice Address - Street 1:645 MCQUEEN SMITH RD N
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7268
Practice Address - Country:US
Practice Address - Phone:355-361-7656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-158032163W00000X
AL2016024249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse