Elizabeth Ellis

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

3360 Issued in SC

Practice address

4390 Belle Oaks Dr
Suite 120
North Charleston, SC 29405-8559

Phone

(866) 571-2700

NPI assigned

Feb 20, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203465600000",
    "number": "1245408566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 QUAIL RUN DR",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310883038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4390 BELLE OAKS DR",
            "address_2": "SUITE 120",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294058559",
            "telephone_number": "866-571-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-20",
        "last_updated": "2008-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "SC",
            "license": "3360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ekklesia Home Care LLC
• Raphael Patrick Ekong
• Brianna Elliott
• Iris A Elliott, LPC
• Britton Morgan Ellis, RN
• Kara Lapin Ellis, FNP
• Kierstan Ellis
• Sophie Ellis, ED.S.
• Tara Russell Ellis, NP
• Tina Marlene Ellis, PA

• Community Health Worker in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Community Health Worker in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 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.