Provider Demographics
NPI:1053091397
Name:ELLISON, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:ELLISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 CAMERON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-8381
Mailing Address - Country:US
Mailing Address - Phone:423-331-3133
Mailing Address - Fax:
Practice Address - Street 1:452 CAMERON RIDGE RD
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-8381
Practice Address - Country:US
Practice Address - Phone:423-331-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program