Provider Demographics
NPI:1316733298
Name:ELLIS, KENPRIL KENISE
Entity type:Individual
Prefix:
First Name:KENPRIL
Middle Name:KENISE
Last Name:ELLIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12008 MIDDLEGROUND RD APT R7
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-3637
Mailing Address - Country:US
Mailing Address - Phone:478-335-4813
Mailing Address - Fax:
Practice Address - Street 1:194 AINSDALE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7821
Practice Address - Country:US
Practice Address - Phone:607-621-5676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician