Provider Demographics
NPI:1881447696
Name:ELLZEY, JESSICA CAITLIN (APRN, DNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:CAITLIN
Last Name:ELLZEY
Suffix:
Gender:F
Credentials:APRN, DNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:CAITLIN
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:678 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1726
Mailing Address - Country:US
Mailing Address - Phone:502-403-7446
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST FL 4
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-7001
Practice Address - Country:US
Practice Address - Phone:859-218-0921
Practice Address - Fax:859-257-1831
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1152126163WP0200X
KY4023701363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No163WP0200XNursing Service ProvidersRegistered NursePediatrics