Active NPI
Carolyn M Ellis, NP
- Nurse Practitioner
- Evansville, IN
National Provider Identifier
1720094808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 71002609A
- Practice address
- 4498 1St Ave
Evansville, IN 47710-3622 - Phone
- (812) 436-7280
- Fax
- (812) 436-7290
- NPI assigned
- Jul 31, 2006
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 71002609A | IN | Primary |
Addresses
Primary practice location
4498 1St Ave
Evansville, IN 47710-3622
Mailing address
PO Box 3407
Evansville, IN 47733-3407
Phone (812) 436-7280
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200829210 | Medicaid | IN |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71002609A | IN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410739200000",
"number": "1720094808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3407",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477333407",
"telephone_number": "812-436-7280",
"fax_number": "812-436-7290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4498 1ST AVE",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477103622",
"telephone_number": "812-436-7280",
"fax_number": "812-436-7290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "CAROLYN",
"middle_name": "M",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-31",
"last_updated": "2014-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IN",
"license": "71002609A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200829210",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.