Kyndra Lenee Ellis, RN, NNP

Primary specialty

Neonatal Nurse PractitionerTaxonomy code 363LN0000X

License

RN154735 Issued in GA

Practice address

443 Gresham Dr
Stockbridge, GA 30281-7716

Phone

(678) 756-1465

Fax

(678) 756-1465

NPI assigned

May 19, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Floyd Physicians, LLC

  • Neonatal-Perinatal Medicine Physician
  • Rome, GA
  • NPI 1992814586
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477872000000",
    "number": "1043477078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "443 GRESHAM DR",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817716",
            "telephone_number": "678-756-1465",
            "fax_number": "678-756-1465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "443 GRESHAM DR",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817716",
            "telephone_number": "678-756-1465",
            "fax_number": "678-756-1465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KYNDRA",
        "middle_name": "LENEE",
        "name_prefix": "Mrs.",
        "credential": "RN, NNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-19",
        "last_updated": "2016-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "154735",
            "primary": false
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "GA",
            "license": "RN154735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elarvetta Homecare
• Elite Health Services, LLC
• Elite Health Services, LLC
• Janet Susan Ellington, DMD
• Dalisha Quanae Ellis
• Shemille Ellis, MD
• Tambrea Toylett Ellison, M.D.
• Embracing Change Counseling Services, LLC
• Endocrine & Diabetes Consultants, PC
• Engage Enterprises, LLC

• Neonatal Nurse Practitioner in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Neonatal Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.