Carol A Ellis, NPC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

NP-825A Issued in ID

Practice address

2315 8TH St
Lewiston, ID 83501-7301

Phone

(208) 746-1383

Fax

(208) 746-6348

NPI assigned

Aug 28, 2007

Last updated

Mar 8, 2016By 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 2

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: carol.ellis.1@12569.direct.athenahealth.com

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

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457395200000",
    "number": "1194919647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2315 8TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835017301",
            "telephone_number": "208-746-1383",
            "fax_number": "208-746-6348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 8TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835017301",
            "telephone_number": "208-746-1383",
            "fax_number": "208-746-6348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "CAROL",
        "middle_name": "A",
        "credential": "NPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-28",
        "last_updated": "2016-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "ID",
            "license": "NP-825A",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP30007996",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEATHLY CONNECTIONS",
            "identifier": "807875800",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "1341036",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807875800",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "NPZA5",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUESHIELD",
            "identifier": "000010005325",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "0226013",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9654294",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melanie T Eggleston, MD
• Janna Michelle Eide Toth, PHARMD
• Dustin Lee Elben, CRNA
• Benjamin Joseph Elger, LMSW-33031
• Stefanie Louise Elliott, OTRL
• Emeritus Properties II, Inc. (Brookdale Lewiston)
• Elizabeth Nicole Emerson, PHARMD
• Nicole M Engledow, ARPN
• Gregory A English, DO
• Jennifer Elaine Erickson, OD

• Adult Health Nurse Practitioner in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Adult Health Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2016; 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.