Kimberly Carol Ellison, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024167810 Issued in VA

Practice address

770 W Ridge Rd Ste 220
Wytheville, VA 24382-1187

Phone

(276) 223-3202

NPI assigned

May 28, 2008

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 2

Medicare fee-for-service enrollment

Enrolled in VA

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

Specialty

Nurse Practitioner

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mount Rogers Community ServicesGroup PAC ID 1254387475, 33 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wythe County Community Hospital Hospital, Wytheville, VA, CCN 490111

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mount Rogers Community Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wytheville, VA
  • NPI 1255365599
  Medicare reassignment Care Compare group NPD
• Royal Oak Medical Associates PC

  dba Smyth County Family Physicians

  • Family Medicine Physician
  • Marion, VA
  • NPI 1720035959
  Medicare reassignment NPD
• Royal Oak Medical Associates PC

  dba Parker Division

  • Family Medicine Physician
  • Chilhowie, VA
  • NPI 1023353893
  NPD
• Royal Oak Medical Associates PC

  dba Blue Ridge Family Medicine

  • Family Medicine Physician
  • Rural Retreat, VA
  • NPI 1588910756
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Wythe County Community Hospital LLC

  dba Wythe County Community Hospital

  • Rural Acute Care Hospital
  • Wytheville, VA
  • NPI 1184706152
  Care Compare affiliation

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

{
    "created_epoch": "1211932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635206400000",
    "number": "1205094174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 W RIDGE RD",
            "city": "WYTHEVILLE",
            "state": "VA",
            "postal_code": "243821187",
            "telephone_number": "276-223-3200",
            "fax_number": "276-223-0617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 W RIDGE RD STE 220",
            "city": "WYTHEVILLE",
            "state": "VA",
            "postal_code": "243821187",
            "telephone_number": "276-223-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "KIMBERLY",
        "middle_name": "CAROL",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-28",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024167810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q008296",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205094174",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia M Duvall
• David Nathaniel Eames, DO
• Susan Nadine Earles, PT MS
• Bart L Eastwood, DO
• Edgemont Center, Inc (Edgemont Rehabilitation and Recovery Center)
• Robert Tyler Epperson, RDN
• Jessica Dawn Evans, PT
• Kimeran Withrow Evans, PHYSICAL THERAPIST
• Everybody Connect Incorporated
• Dalkeith George Facey, D.O. MBA

• Family Nurse Practitioner in Wytheville, VA
• Providers in Wytheville, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.