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Kimberly Frances Ellis

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

9900 Bren Road East, Mail Route Mn 008-B213, Minnetonka, MN 55343-9664

PECOS Enrollment

This provider is enrolled in PECOS as KIMBERLY ELLIS.

Based on the most recent information from CMS, provider Kimberly Frances Ellis is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1972860591
Provider Type
Individual
Full Name
Ellis, Kimberly Frances
Title
Mrs.
Credential
FNP-C

Gender
Female
Sole Proprietor
No
Enumeration Date
4/19/2012
Last Updated
9/25/2023

Contact Information

Practice Location

9900 Bren Road East, Mail Route Mn 008-B213, Minnetonka, MN 55343-9664

(817) 908-5519

Unlisted Fax

Mailing Location

707 Carolyn T Hunt Dr, Cedar Hill, TX 75104-7347

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License AP121757 Texas
Code 363L00000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 210390 Oklahoma
Code 363LF0000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License A121757 Texas

Kimberly Frances Ellis

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

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Berry, Wakiya

Katamba, Sarah Janet

Abara, Rosalind

Jabido, Maria Luisa

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Schultz, Jane M

Gordon, Safiya A