Kimberly Ellis, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

44540 Issued in WV

Practice address

104 Logan St
Williamson, WV 25661-3606

Phone

(304) 236-5902

Fax

(304) 235-8150

NPI assigned

Jan 4, 2021

Last updated

Jan 4, 2021By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Williamson Health & Wellness Center Inc

  dba Williamson Health & Wellness Center-Behavioral Medicine Clinic

  • Federally Qualified Health Center (FQHC)
  • Williamson, WV
  • NPI 1386115905
  Medicare reassignment NPD
• Williamson Health & Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Williamson, WV
  • NPI 1467711150
  Medicare reassignment NPD
• Williamson Health & Wellness Center Inc

  dba Williamson Health & Wellness Center - Gilbert

  • Federally Qualified Health Center (FQHC)
  • Gilbert, WV
  • NPI 1730669524
  Medicare reassignment NPD
• Williamson Health & Wellness Center Inc

  dba Williamson Health & Wellness Center -Licensed Behavioral Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Williamson, WV
  • NPI 1942840384
  Medicare reassignment NPD
• Williamson Health & Wellness Center Inc

  dba Williamson Health & Wellness Center-Mingo Central High School

  • Federally Qualified Health Center (FQHC)
  • Delbarton, WV
  • NPI 1225684731
  NPD

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

{
    "created_epoch": "1609718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1972191195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 LOGAN ST",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256613606",
            "telephone_number": "304-236-5902",
            "fax_number": "304-235-8150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 LOGAN ST",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256613606",
            "telephone_number": "304-236-5902",
            "fax_number": "304-235-8150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KIMBERLY",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-04",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "44540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Edmiston, LPN
• Stan Elkins
• Tondra Elkins
• Anitra Marie Ellis, NP-C
• Corrinna Kay Ellis
• Alice Marie Endicott
• Nikita Kaye Endicott
• Deborah Gail Epling, FNP-C
• Ess of Williamson, LLC
• Crystal Lynn Estepp

• Family Nurse Practitioner in Williamson, WV
• Providers in Williamson, WV by specialty
• Family Nurse Practitioner in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.