Beverly Dawn Ellis, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3010157 Issued in KY

Practice address

1484 Lakeside Drive
Jackson, KY 41339-6555

Phone

(606) 666-9950

Fax

(606) 666-9136

NPI assigned

Mar 7, 2016

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

Medicare fee-for-service enrollment

Enrolled in KY

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

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: beverlyellis@juniperhea.allscriptsdirect.net

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.

• Juniper Health Inc

  • Federally Qualified Health Center (FQHC)
  • Beattyville, KY
  • NPI 1407818628

  KY

  Medicare reassignment NPD
• QPS LLC

  • Community/Retail Pharmacy
  • Sandy Hook, KY
  • NPI 1538901186
  NPD
• Juniper Health Inc

  • Federally Qualified Health Center (FQHC)
  • Jackson, KY
  • NPI 1467417691
  NPD (past)

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

{
    "created_epoch": "1457308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651622400000",
    "number": "1124488903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 690",
            "city": "BEATTYVILLE",
            "state": "KY",
            "postal_code": "413110690",
            "telephone_number": "606-464-0151",
            "fax_number": "606-464-0152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1484 LAKESIDE DRIVE",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413396555",
            "telephone_number": "606-666-9950",
            "fax_number": "606-666-9136"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "308 N KY 7",
            "address_purpose": "LOCATION",
            "city": "Sandy Hook",
            "state": "KY",
            "postal_code": "411717134",
            "country_code": "US",
            "telephone_number": "606-738-9785",
            "fax_number": "859-317-2148",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "202 Plummer St",
            "address_purpose": "LOCATION",
            "city": "Campton",
            "state": "KY",
            "postal_code": "413019381",
            "country_code": "US",
            "telephone_number": "606-668-7385",
            "fax_number": "606-668-7009",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1219 W Main St",
            "address_purpose": "LOCATION",
            "city": "West Liberty",
            "state": "KY",
            "postal_code": "414722161",
            "country_code": "US",
            "telephone_number": "606-743-4808",
            "fax_number": "606-743-4716",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "BEVERLY",
        "middle_name": "DAWN",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-07",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3010157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dr. Rodney B. Griffith
• Everett Lane Dunaway
• Portia Ann Dunaway, RPH
• Jerrica Duty, APRN
• Mary Elizabeth Eldridge, PA-C
• Tara Epperson, LCSW
• Eyemart Family Vision Care Inc
• Family Medical Specialty Clinic D.B.a.
• Family Medical Specialty Clinic PLLC
• Flying Eye PLLC

• All providers in Jackson, KY
• Family Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; 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.