John Kenny Ellison, RN

Primary specialty

Emergency Registered NurseTaxonomy code 163WE0003X

License

R21266 Issued in NM

Practice address

12516 Crestline Ave NE
Albuquerque, NM 87112-3616

Phone

(505) 323-9170

NPI assigned

May 21, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730398546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12516 CRESTLINE AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871123616",
            "telephone_number": "505-323-9170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12516 CRESTLINE AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871123616",
            "telephone_number": "505-323-9170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "JOHN",
        "middle_name": "KENNY",
        "name_prefix": "Mr.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "NM",
            "license": "R21266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Moira Louise Ellis
• William D Ellis, M.D.
• Crystal Ellison, LCSW
• Ja'Lyn Ellison
• Jasmine Nichole Ellison
• Katera Ellison
• Tammy Kendal Ellison, LCSW
• Sarah Jane Ellsworth, MD
• Diane Elman
• Shana Elman, M.D.

• Emergency Registered Nurse in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Emergency Registered Nurse in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.