Ellison, Kenneth Robert
Ellison, Kenneth Robert is an individual health care provider with primary practice located at 1032 Mar Walt Dr Suite 250, Fort Walton Beach FL 32547-6661. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Ellison, Kenneth Robert can be contacted via phone (850) 863-3463.Contact Information
Primary practice address
1032 Mar Walt Dr Suite 250
Fort Walton Beach FL 32547-6661
Phone: (850) 863-3463
Fax: (850) 315-6051
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 9106823 | Florida |
Profile Details
| NPI number | 1831122803 |
|---|---|
| LBN Legal business name | Ellison, Kenneth Robert |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 10th, 2006 |
| Last updated | Jan 14th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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