Marty Leon Ellis, APRN, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Holton, KS
NPI 1225752033 · NPPES record last updated Sep 27, 2022
Key facts
- NPI
- 1225752033
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 81573 (KS)
- Practice address
- 23020 M Rd
Holton, KS 66436-8641 - Phone
- (785) 362-8677
- NPI assigned
- Sep 27, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
- Opted out of Medicare
- Yes, effective Nov 4, 2022 through Nov 4, 2026
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 81573 | KS | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 81573 | KS | Yes |
Addresses
Primary practice location
23020 M Rd
Holton, KS 66436-8641
Mailing address
23020 M Rd
Holton, KS 66436-8641
Phone (785) 362-8677
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Marty@holtondirectcare.com | Direct |
Other providers in Holton, KS
- CPF Senior Living - Holton LLC
- Heather Crispin
- Rachel Helen Dahl
- Edward D. McKenzie
- Sarrah R Edwards
- Shaley Emmons
- Michael Kevin Engelken
- Jon Fetterhoof
- Mackenzie Forrester
- Gallagher Eye Care of Holton
All providers in Holton, KS · Family Nurse Practitioner in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2022. 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).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.