Active NPI
Kirsten Wilson Ellis, NP
- Family Nurse Practitioner
- Greenbrae, CA
National Provider Identifier
1346497658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 18219
- Practice address
- 1350 S Eliseo Dr
Ste 130
Greenbrae, CA 94904-2011 - Phone
- (415) 238-0203
- NPI assigned
- Aug 19, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 18219 | CA | Primary |
Addresses
Primary practice location
1350 S Eliseo Dr
Ste 130
Greenbrae, CA 94904-2011
Mailing address
1350 S Eliseo Dr
Ste 130
Greenbrae, CA 94904-2011
Phone (415) 238-0203
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18219 | Other | CA | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219104000000",
"number": "1346497658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1350 S ELISEO DR",
"address_2": "STE 130",
"city": "GREENBRAE",
"state": "CA",
"postal_code": "949042011",
"telephone_number": "415-238-0203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 S ELISEO DR",
"address_2": "STE 130",
"city": "GREENBRAE",
"state": "CA",
"postal_code": "949042011",
"telephone_number": "415-238-0203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "KIRSTEN",
"middle_name": "WILSON",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-19",
"last_updated": "2008-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "18219",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "18219",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenbrae, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.