Provider Demographics
NPI:1881233914
Name:ELLIS, BARBARA FAYE (APRN)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:FAYE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 BREWER RD
Mailing Address - Street 2:
Mailing Address - City:EDGEMONT
Mailing Address - State:AR
Mailing Address - Zip Code:72044-9539
Mailing Address - Country:US
Mailing Address - Phone:501-626-4043
Mailing Address - Fax:
Practice Address - Street 1:4250 BREWER RD
Practice Address - Street 2:
Practice Address - City:EDGEMONT
Practice Address - State:AR
Practice Address - Zip Code:72044-9539
Practice Address - Country:US
Practice Address - Phone:501-626-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAG01200007363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology