Active NPI
Adrian Ellis Short
- Clinical Nurse Specialist
- Cypress, TX
National Provider Identifier
1417628793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Nurse Specialist
- License
- 305776
- Practice address
- 15402 Hazen Point Dr
Cypress, TX 77433-6186 - Phone
- (203) 506-1529
- NPI assigned
- Sep 25, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Nurse Specialist | 364S00000X | 305776 | TX | Primary |
Addresses
Primary practice location
15402 Hazen Point Dr
Cypress, TX 77433-6186
Mailing address
PO Box 2306
Cypress, TX 77410-2306
Phone (203) 506-1529
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 305776 | TX | MD | Clinical Nurse Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632528000000",
"number": "1417628793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2306",
"city": "CYPRESS",
"state": "TX",
"postal_code": "774102306",
"telephone_number": "203-506-1529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15402 HAZEN POINT DR",
"city": "CYPRESS",
"state": "TX",
"postal_code": "774336186",
"telephone_number": "203-506-1529"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS SHORT",
"first_name": "ADRIAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-09-25",
"last_updated": "2021-09-25",
"certification_date": "2021-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "364S00000X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist",
"state": "TX",
"license": "305776",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cypress, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.