Gwyndolyn Ellis, RN, LAT, ATC is a
Specialist/technologist - Athletic Trainer based in Fort Campbell, Kentucky. Gwyndolyn Ellis is licensed to practice in Texas (license number AT7218) and her current practice location is
650 Joel Dr, Fort Campbell, Kentucky. She can be reached at her office (for appointments etc.) via phone at
(270) 798-8400.
NPI number for Gwyndolyn Ellis is 1518455716 and her current mailing address is 102 Eaglewood Ct, Clarksville, Tennessee. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1518455716.
Provider's Profile
Full Name | Gwyndolyn Ellis |
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Gender | Female |
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Speciality | Specialist/technologist - Athletic Trainer |
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Location | 650 Joel Dr, Fort Campbell, Kentucky |
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Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1518455716
- Provider Enumeration Date: 04/24/2018
- Last Update Date: 12/21/2023
Medical Identifiers
Medical identifiers for Gwyndolyn Ellis such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1518455716 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
163W00000X | Registered Nurse | 922427 (Texas) | Secondary |
2255A2300X | Specialist/technologist - Athletic Trainer | AT7218 (Texas) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Gwyndolyn Ellis is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Gwyndolyn Ellis, RN, LAT, ATC 102 Eaglewood Ct, Clarksville, TN 37042-1414 Ph: () - | Gwyndolyn Ellis, RN, LAT, ATC 650 Joel Dr, Fort Campbell, KY 42223-5318 Ph: (270) 798-8400 |
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