Patricia Ellis, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

651244 Issued in NC

Practice address

25 Courthouse Dr NE
Bolivia, NC 28422

Phone

(888) 428-4429

Fax

(910) 253-2379

NPI assigned

Jul 9, 2008

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• County of Brunswick

  • State or Local Public Health Clinic/Center
  • Bolivia, NC
  • NPI 1356498794
  NPD (past)

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

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215561600000",
    "number": "1154584191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 COURTHOUSE DR NE PO BOX 9",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "28422",
            "telephone_number": "888-428-4429",
            "fax_number": "910-253-2379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 COURTHOUSE DR NE",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "28422",
            "telephone_number": "888-428-4429",
            "fax_number": "910-253-2379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "PATRICIA",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-09",
        "last_updated": "2008-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "NC",
            "license": "L001598",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "651244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Breanna Lynn Durbin, MD
• DW-N-ER, Inc.
• East Carolina University
• Selena Anne Ehlert, OTR/L
• Lani Ellis, P.A.-C
• Patrick Christopher Ellis, MD
• Essential Medical Response, LLC
• Heidi Beth Everett, OTR/L
• Kayla Rose Eza, LCSWA
• William Joseph Faircloth, MD

• Registered Dietitian in Bolivia, NC
• Providers in Bolivia, NC by specialty
• Registered Dietitian in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; 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.