Kelley D Ellis, RNFA, CNOR

Primary specialty

Medical-Surgical Registered NurseTaxonomy code 163WM0705X

License

551667 Issued in TX

Practice address

1900 Mistletoe Blvd Ste 200
Fort Worth, TX 76104-4049

Phone

(817) 878-5333

Fax

(817) 878-5334

NPI assigned

Aug 29, 2006

Last updated

Feb 4, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549238400000",
    "number": "1073622858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 MISTLETOE BLVD STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044049",
            "telephone_number": "817-878-5333",
            "fax_number": "817-878-5334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 MISTLETOE BLVD STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044049",
            "telephone_number": "817-878-5333",
            "fax_number": "817-878-5334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KELLEY",
        "middle_name": "D",
        "credential": "RNFA, CNOR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2019-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "TX",
            "license": "551667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7521427",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0672032",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TX",
            "identifier": "89N921",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Debra Kay Ellis, LPC, LBSW,ACBSW
• Eddie Ellis
• Evyn Ellis, LPC
• Gregory Sean Ellis, DDS
• Jeremy Ellis, D.C.
• Lorenzo Paul Ellis
• Renee Ann Ellis, M.D.
• Sundie Wright Ellis, APRN, BC, FNP
• Thomas S Ellis, M.D.
• Danielle Elizabeth Ellison

• Medical-Surgical Registered Nurse in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Medical-Surgical Registered Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.