DR. CAROLYN ANN ELLSWORTH (NPI# 1679570618) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679570618 |
| Entity Type | Individual |
| Full Name | DR. CAROLYN ANN ELLSWORTH |
| Credential | M.D. |
| Practice Address |
312 N Kentucky St West Plains MO 65775-2073 |
| Practice Telephone | 4172577076 |
| Practice Fax Number | 4172571417 |
| Mailing Telephone | 4172577076 |
| Mailing Fax Number | 4172571417 |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2011-11-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
102421 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | 123942001 | 05 | |
| MO | 203592001 | 05 |
| Street Address |
312 N KENTUCKY ST |
| City | WEST PLAINS |
| State | MO |
| Zip Code | 65775-2073 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396836649 | Bill Stafford, M.d. | Pediatrics | 312 N Kentucky St, West Plains, MO 65775-2073 | 2006-09-28 |
| 1447257324 | Ellen Bivens | Physician Assistant | 312 N Kentucky St, West Plains, MO 65775-2073 | 2005-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598373359 | Ozarks Medical Center | Clinic/Center | Omc/zizzer Clinic, 1013 College Street, West Plains, MO 65775 | 2020-07-17 |
| 1962958678 | Fanny Ray | Massage Therapist | 1105 Independence Drive, West Plains, MO 65775 | 2016-09-01 |
| 1295184166 | Shaunda Faye Wolfe | Case Manager/Care Coordinator | 2301 K Hwy Apt. 2, West Plains, MO 65775 | 2016-06-10 |
| 1740694009 | Mary Loretta Rogganbuck | Counselor | 1211 Porter Wagoner #23, West Plains, MO 65775 | 2014-06-16 |
| 1548673858 | John Tollenaar | Physical Therapist | 1480 8th Streeet, West Plains, MO 65775 | 2014-06-04 |
| 1861818080 | Raymond Eugene Richardson | Case Manager/Care Coordinator | 1015 Lanton Road, West Plains, MO 65775 | 2014-03-12 |
| 1710309083 | Jared M Sadowitz | Physical Therapist | 1100 Kentucly Ave, West Plains, MO 65775 | 2014-01-06 |
| 1346682184 | Mark L. Dake Dds, Msd and David Sander Dmd, Mds | Dentist | 181 N. Kentucky, Suite 300, West Plains, MO 65775 | 2013-07-22 |
| 1427307024 | Anita M. Nelson | Behavioral Analyst | 8388 Pr 2731, West Plains, MO 65775 | 2012-08-29 |
| 1780959684 | Ozarks Medical Center | Pharmacy | 18 Parkway Center, West Plains, MO 65775 | 2012-03-12 |
| Find all providers in zip 65775 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528064102 | Joseph William Stafford Jr. | Pediatrics | 312 N Kentucky Ave, West Plains, MO 65775-2073 | 2005-06-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366670796 | Fernando Fernandez, M. D. PC | Pediatrics | 2750 Clay Edwards Dr Ste 320, North Kansas City, MO 64116-3259 | 2009-06-24 |
| 1073733069 | Kelly Jo Meier | Pediatrics | 2719 E 32nd St, Joplin, MO 64804-3131 | 2007-05-01 |
| 1114048154 | Affton Medical Clinic | Pediatrics | 59 Grasso Plz, Saint Louis, MO 63123-3107 | 2007-04-03 |
| 1851417794 | Shari L Smith | Pediatrics | 200 Castle Drive, Joplin, MO 64804-9115 | 2007-03-22 |
| 1811076763 | Nedra Diann Twillie | Pediatrics | 415 Burkarth Rd Ste D, Warrensburg, MO 64093-3101 | 2006-11-03 |
| 1740209162 | Nancy Elizabeth Holmes | Pediatrics | 8888 Ladue Road, Suite 130, St. Louis, MO 63124 | 2006-07-18 |
| 1194770883 | Ann A Gassman | Pediatrics | 503 N Scott Ave, Belton, MO 64012-1730 | 2006-05-23 |
| 1841299161 | Bryson Roy Mchardy Jr. | Pediatrics | 100 Medical Dr, Hannibal, MO 63401-6877 | 2005-07-19 |
| 1245239797 | Jeffrey Paul Yannette | Pediatrics | 821 Sw Lemans Lane, Lees Summit, MO 64082 | 2005-07-18 |
| 1447784152 | Children's Mercy - Cass County Pediatrics & Adolescents | Pediatrics | 503 N Scott Ave, Belton, MO 64012-1730 | 2017-04-19 |
| Find all providers with the same taxonomy | ||||
| City | WEST PLAINS |
| Zip Code | 65775 |
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| 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.