Provider Demographics
NPI:1255341434
Name:ELLIS, KAREN L (RN, ANP-C)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:ELLIS
Suffix:
Gender:F
Credentials:RN, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SANDELWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7855
Mailing Address - Country:US
Mailing Address - Phone:409-651-2676
Mailing Address - Fax:
Practice Address - Street 1:810 HOSPITAL DR STE 200
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4654
Practice Address - Country:US
Practice Address - Phone:409-212-5512
Practice Address - Fax:409-212-5898
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP110025363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N8667OtherBLUE CROSS & BLUE SHIELD
TX147715001Medicaid
TX8N8667OtherBLUE CROSS & BLUE SHIELD