Kerri Lee Ellis, A.R.N.P.
Individual provider Active NPI Family Nurse Practitioner · Beggs, OK
NPI 1447409206 · NPPES record last updated Sep 30, 2021
Key facts
- NPI
- 1447409206
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 53535 (OK)
- Practice address
- 103 E Main St
Beggs, OK 74421 - Phone
- (918) 267-7000
- Fax
- (918) 267-7077
- NPI assigned
- Sep 16, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Hospital & facility affiliations 6
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- University of Oklahoma College of Medicine, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
103 E Main
Beggs, OK 74421
Phone (918) 367-0010
Hospital & facility affiliations
- Mays Home Health of NC Ok
- A Path of Care Sooner Home Health
- Complete Home Health of Western Oklahoma
- Muscogee (Creek) Nation Medical Center
- Ascension St John Sapulpa
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Clinico LLC |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Corporate Director (100%) |
Oct 25, 2001 Oct 25, 2001 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091030000187 | OK | Practitioner - Nurse Practitioner | 2163569971 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53535 | OK | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinico LLC | Current |
Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/ADEAED/Endpoint/ADEAED
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 53535 | OK | Yes |
Addresses
Primary practice location
103 E Main St
Beggs, OK 74421
Mailing address
PO Box 478
103 E Main St
Beggs, OK 74421-0478
Phone (918) 367-0010
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100708410B | Medicaid | OK |
Other providers in Beggs, OK
- Pamela Lynn Bookout
- Karen Busby
- Clinico LLC
- Candice Joy Craig
- Katherine Rene Dossey
- Foot and Ankle Specialists of Green Country
- Green Country Sleep, LLC
- Brittany Hopper
- Victoria Lynn Jones
- Whindrea Bana Jones
All providers in Beggs, OK · Family Nurse Practitioner in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2021. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.