Amber Ellis, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Logan, WV
NPI 1093049983 · NPPES record last updated Sep 9, 2011
Key facts
- NPI
- 1093049983
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 61591 (WV)
- Practice address
- 140 Stollings Ave
Suite 3
Logan, WV 25601-4035 - Phone
- (304) 752-4594
- NPI assigned
- Sep 24, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Living Waters Medical Center
Practice addresses (Care Compare)
100 Main Ave
Logan, WV 25601-3323
Phone (304) 896-2553
Hospital & facility affiliations
- Dignity Home Health
- Logan Regional Medical Center
- Boone Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100114000031 | WV | Practitioner - Nurse Practitioner | 7113068057 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthy Habits Wellness Ctr, Inc | Current |
Accepting new patients | |
| Living Waters Medical Center | Current |
Accepting new patients |
Locations
100 Main Ave
Logan, WV 25601
Phone (304) 831-6700
258 Hanging Rock Hwy
Ste 3
Logan, WV 25601
Phone (304) 752-4405
861 Cook Pkwy
Oceana, WV 24870
Phone (304) 890-9811
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 61591 | WV | Yes |
Addresses
Primary practice location
140 Stollings Ave
Suite 3
Logan, WV 25601-4035
Mailing address
140 Stollings Ave
Suite 3
Logan, WV 25601-4035
Phone (304) 752-4594
Other providers in Logan, WV
- Diana Alec Elkins
- Kaitlyn Jewell Elkins
- Misti Dawn Elkins
- Sierra Elliott
- Alissa Ellis
- Barbara J Ellis
- Melinda Ellis
- Elm Emergency Group PLLC
- Emmanuel O. Soyoola MD PC
- Ayla Engebretson
All providers in Logan, WV · Family Nurse Practitioner in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.