Active NPI
Katherine Ellenwood
- Community Health Worker
- Greensboro, NC
National Provider Identifier
1063950178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 6180
- Practice address
- 3698 Cotswold Ave
3C
Greensboro, NC 27410-9634 - Phone
- (336) 402-4292
- NPI assigned
- Feb 9, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 6180 | NC | Primary |
Addresses
Primary practice location
3698 Cotswold Ave
3C
Greensboro, NC 27410-9634
Mailing address
3698 Cotswold Ave
3C
Greensboro, NC 27410-9634
Phone (336) 402-4292
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6180 | NC | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486598400000",
"number": "1063950178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3698 COTSWOLD AVE",
"address_2": "3C",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274109634",
"telephone_number": "336-402-4292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3698 COTSWOLD AVE",
"address_2": "3C",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274109634",
"telephone_number": "336-402-4292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLENWOOD",
"first_name": "KATHERINE",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-02-09",
"last_updated": "2017-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NC",
"license": "6180",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.