Provider Demographics
NPI:1285300772
Name:ELLINGTON, MARY VIRGINIA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:VIRGINIA
Last Name:ELLINGTON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1871 US HIGHWAY 41A S
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:KY
Mailing Address - Zip Code:42409-9448
Mailing Address - Country:US
Mailing Address - Phone:270-249-6037
Mailing Address - Fax:270-440-0007
Practice Address - Street 1:1871 US41A SOUTH
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:KY
Practice Address - Zip Code:42409
Practice Address - Country:US
Practice Address - Phone:270-543-6372
Practice Address - Fax:270-440-2109
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3016526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily