Ellis, Danny

Ellis, Danny is an individual health care provider with primary practice located at 2100 Highway 61 N , Vicksburg MS 39183-8211. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Gerontology. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is his primary health care specialty. Ellis, Danny can be contacted via phone (601) 883-4250.

Contact Information

Primary practice address
2100 Highway 61 N Vicksburg MS 39183-8211
Phone: (601) 883-4250
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X R826981 Mississippi
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X R826981 Mississippi

Profile Details

NPI number 1760699540
LBN Legal business name Ellis, Danny
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2007
Last updated Aug 12th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760699540 NPPES
Mississippi MEDICAID 00634567
Mississippi MEDICAID 1029611

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