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KENNETH ELLIS CASE MANAGER

>> Case Manager/Care Coordinator >> Other Service Providers

Registrant NPI Number: 1992212633

Individual Registrant:
 KENNETH  ELLIS CASE MANAGER
Gender: M
Not Sole Proprietor

Location and contact information for practice:
1802 HWY 82 WEST  CROSSETT, AR 71635 US
Tel: 870-364-7248  Fax: 870-364-2249

Contact information for business:
790 ROBERTS DR  MONTICELLO, AR 71655-5723 US
Tel: 870-367-2461  Fax: 870-460-6133

Registration Information:
NPI: 1992212633
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y171M00000XOther Service Providers
Case Manager/Care Coordinator
AR

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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