Provider Demographics
NPI:1548074081
Name:ELLIS, ASHLEY ROSE (CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ROSE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 GRACE DR NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1334
Mailing Address - Country:US
Mailing Address - Phone:919-696-5744
Mailing Address - Fax:
Practice Address - Street 1:1702 MEDICAL PARK DR W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-2878
Practice Address - Country:US
Practice Address - Phone:252-243-7944
Practice Address - Fax:252-243-6097
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021616363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics