Jacqueshia Lynette Ellis, A.A

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

172V00000X Issued in NV

Practice address

900 W 1St St Ste 200
Reno, NV 89503-5587

Phone

(775) 677-2216

NPI assigned

Feb 3, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Tweety Tweety Tweety Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Associate of Arts

State licenses

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

{
    "created_epoch": "1296691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296691200000",
    "number": "1467758706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 W 1ST ST STE 200",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895035587",
            "telephone_number": "775-677-2216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 W 1ST ST STE 200",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895035587",
            "telephone_number": "775-677-2216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "JACQUESHIA",
        "middle_name": "LYNETTE",
        "name_prefix": "Ms.",
        "credential": "A.A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-02-03",
        "last_updated": "2011-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NV",
            "license": "172V00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TWEETY",
            "last_name": "TWEETY",
            "middle_name": "TWEETY",
            "prefix": "MS.",
            "credential": "A.A",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Agatha Ellis
• Alyssa Jordan Ellis
• Anna Ellis, APRN
• Danielle Ellis, LMFT
• David Ellis, DPM
• Makayla Ellis
• Terry Allan Ellis II, MD
• Eric Elmore
• Jessica Elmore, LMSW
• Karen Elmore

• Community Health Worker in Reno, NV
• Providers in Reno, NV by specialty
• Community Health Worker in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2011; 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.