KEISHA ELLIS NP NPI 1508318494

NPI Information

NPI: 1508318494
Provider Name: KEISHA ELLIS, NP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

Organization: ROSWELL CLINIC CORP

PECOS Registration: Yes

Address:
603 W COUNTRY CLUB RD
ROSWELL, NM
ZIP 88201
Phone: (575) 624-4922
Get Directions

Keisha Ellis, NP is a family nurse practitioner in Roswell, NM with 8 years of experience. Keisha Ellis, NP NPI is 1508318494. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

603 W COUNTRY CLUB RD
ROSWELL, NM
ZIP 88201-211
Phone: (575) 624-4922
Fax: (575) 624-4902

The NPI 1508318494 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/26/2016 and was last updated on 3/7/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	9281197	FLORIDA	No
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	CNP-03387	NEW MEXICO	No
3	363LF0000X	Nurse Practitioner	Family	CNP03387	NEW MEXICO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	44672322	MEDICAID	NEW MEXICO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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