Kathleen S. Ellis

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

001 Issued in WV

Legal business name

KATHLEEN S. ELLIS

Practice address

327 State St
Madison, WV 25130-1367

Phone

(304) 369-7964

Fax

(304) 369-7005

NPI assigned

Oct 25, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathleen S Ellis

Title

Owner/Manager

Phone

(304) 369-7964

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Boone HomeCare Supplies Doing business as

Locations

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1386728038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "327 STATE ST",
            "address_2": "PO BOX 98",
            "city": "MADISON",
            "state": "WV",
            "postal_code": "251301367",
            "telephone_number": "304-369-7964",
            "fax_number": "304-369-7005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 STATE ST",
            "city": "MADISON",
            "state": "WV",
            "postal_code": "251301367",
            "telephone_number": "304-369-7964",
            "fax_number": "304-369-7005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHLEEN S. ELLIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "304-369-7964"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WV",
            "license": "001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0147485000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boone HomeCare Supplies",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Heather Renae Johnston
• Allison Jones
• Kristen N Jones
• Mathew Lewis Jones
• Tasha Jones
• Ariel Eve Keeling
• Carrie Kelley
• Sriramloo Kesari, MD
• Suzana Kinder
• Barbara L King

• Durable Medical Equipment & Medical Supplies in Madison, WV
• Providers in Madison, WV by specialty
• Durable Medical Equipment & Medical Supplies in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.