Active NPI
Kaitlyn Ellsworth
- Pediatric Nurse Practitioner
- Biloxi, MS
National Provider Identifier
1790549483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 905766
- Practice address
- 2561 Pass Rd Ste D
Biloxi, MS 39531-2712 - Phone
- (228) 400-0098
- NPI assigned
- Feb 12, 2024
- 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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 905766 | MS | Primary |
Addresses
Primary practice location
2561 Pass Rd Ste D
Biloxi, MS 39531-2712
Mailing address
11616 Talla Dr
Ocean Springs, MS 39564-7808
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 |
|---|---|---|---|
| 905766 | MS | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707696000000",
"number": "1790549483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11616 TALLA DR",
"city": "OCEAN SPRINGS",
"state": "MS",
"postal_code": "395647808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2561 PASS RD STE D",
"city": "BILOXI",
"state": "MS",
"postal_code": "395312712",
"telephone_number": "228-400-0098"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLSWORTH",
"first_name": "KAITLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-12",
"last_updated": "2024-02-12",
"certification_date": "2024-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MS",
"license": "905766",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Biloxi, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.