CARLY ELLISON (NPI# 1508245028) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508245028 |
| Entity Type | Individual |
| Full Name | CARLY ELLISON |
| Credential | APN |
| Practice Address |
2901 Old Jacksonville Rd Springfield IL 62704-7437 |
| Practice Telephone | 2176989722 |
| Practice Fax Number | 2173910392 |
| Mailing Telephone | 2176989722 |
| Mailing Fax Number | 2173910392 |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2016-04-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
209012884 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
209012884 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2901 OLD JACKSONVILLE RD |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62704-7437 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467441550 | Julio Cesar Vijil Sr. | Surgery | 2901 Old Jacksonville Rd, Suite B3, Springfield, IL 62704-7439 | 2005-10-20 |
| 1316591761 | Shelby Kern | Nurse Practitioner | 2901 Old Jacksonville Rd, Springfield, IL 62704-7437 | 2019-07-24 |
| 1609392091 | Tamara Hardwick | Nurse Practitioner | 2901 Old Jacksonville Rd, Springfield, IL 62704-7437 | 2017-08-17 |
| 1598217978 | Amy J Welch | Registered Nurse | 2901 Old Jacksonville Rd, Springfield, IL 62704-7437 | 2016-11-01 |
| 1316399140 | Neesha Settipalle | Internal Medicine | 2901 Old Jacksonville Rd, Springfield, IL 62704 | 2016-07-05 |
| 1013395250 | Gopinathan Gangadharan Nambiar | Pediatrics | 2901 Old Jacksonville Rd, Springfield, IL 62704-7437 | 2015-05-07 |
| 1467849257 | Hshs Medical Group Inc | Durable Medical Equipment & Medical Supplies | 2901 Old Jacksonville Rd, Springfield, IL 62704-7437 | 2015-04-20 |
| 1225443484 | Erin Blackburn | Pediatrics | 2901 Old Jacksonville Rd, Springfield, IL 62704-7437 | 2014-06-26 |
| 1801209291 | Jieun Heo | Family Medicine | 2901 Old Jacksonville Rd, Springfield, IL 62704-7437 | 2014-06-03 |
| 1265872097 | Noureen Zohra | Family Medicine | 2901 Old Jacksonville Rd, Suite A, Springfield, IL 62704-7437 | 2013-06-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902394901 | Hillary Haaker | Occupational Therapist | 2035 W Iles, Suite C, Springfield, ID 62704 | 2018-04-25 |
| 1871095364 | Edward Doyle Slifer Sr. | Pathology | 2117 Greenside Drive, Spring Field, IL 62704 | 2018-03-01 |
| 1598263345 | Santarelli & Feller Dental Group | Dentist | 1140 Rickard Road, Suite B, Springfield, IL 62704 | 2018-01-26 |
| 1447774757 | Lisa Ann Rogers | Developmental Therapist | 2101 Lexington Dr, Apt 3, Springfield, IL 62704 | 2017-07-28 |
| 1730611286 | Mindi Rowe | Occupational Therapist | 2508 County Rd 4 1/2 E, Springfield, IL 62704 | 2017-04-03 |
| 1366992208 | Jayme Jordan | Contractor | 2409 Westchester Blvd, Springfield, IL 62704 | 2016-10-04 |
| 1154793974 | Dina Payne | Social Worker | 917 Clocktower Drive, Suite 600, Springfield, IL 62704 | 2015-10-21 |
| 1770959819 | James R Reynolds | Hearing Instrument Specialist | 2347 W Monroe St, Springfield, IL 62704 | 2015-08-12 |
| 1336576495 | Emily Jane Dungey | Counselor | 920 S Spring St Ste 1300, Springfield, IL 62704 | 2013-10-03 |
| 1942552161 | Jeannie Marie Hundley | Specialist/Technologist, Other | 2921 Monvale Drive, Springfield, IL 62704 | 2012-10-11 |
| Find all providers in zip 62704 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699382580 | Pamela Dawn Raines | Nurse Practitioner | 4311 Autumn Creek Dr, Springfield, OH 45504-5112 | 2020-09-25 |
| 1134735343 | Michael Fitz | Nurse Practitioner | 6205 Westminster Ct, Springfield, IL 62711-6728 | 2020-09-22 |
| 1326694605 | Affirm Management and Consulting, LLC | Nurse Practitioner | 4728 S Campbell Ave Ste 128, Springfield, MO 65810-1715 | 2019-08-13 |
| 1548812506 | Sasha Lee Ramos | Nurse Practitioner | 125 Liberty St Ste 403, Springfield, MA 01103-1109 | 2019-07-10 |
| 1427530591 | Matthew Smith | Nurse Practitioner | 196 W Sproul Rd Ste 205, Springfield, PA 19064-2045 | 2018-09-05 |
| 1083167100 | Talona Sue Carpenter-schultz | Nurse Practitioner | 322 Mcintyre Ln, Springfield, MI 49037-7685 | 2016-07-25 |
| 1649632068 | Lori Brooks | Nurse Practitioner | 1307 E Monroe St, Springfield, IL 62703-1224 | 2016-03-24 |
| 1740613744 | Sanyu Haffusa Walker | Nurse Practitioner | 3550 Main St. Commonwealth Community Care, Suite 101, Springfield, MA 01107-1078 | 2013-08-13 |
| 1023030145 | Bernice A Ezell | Nurse Practitioner | 380 Plainfeild St, Springfield, MA 01199-0001 | 2006-07-25 |
| 1952948176 | Alireza Jarihi | Nurse Practitioner | 305 Bicentennial Hwy, Springfield, MA 01118-1962 | 2019-12-06 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62704 |
Please comment or provide details below to improve the information on CARLY ELLISON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.