IndividualActive
Kathleen Ellis, PA-C
NPI 1891570545 · Surgical Physician Assistant · Mishawaka, IN
Provider details
- NPI number
- 1891570545
- Entity type
- Individual
- Primary specialty
- Surgical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- License
- 10004107A (IN)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
611 E Douglas Rd Ste 207
Mishawaka, IN 46545-1465
Phone: (574) 335-6850
Approximate (ZIP-level) locationGet directions
Mailing address
5215 Holy Cross Pkwy
Mishawaka, IN 46545-1469
Registry dates
- Enumerated
- 2023-08-30
- Last updated
- 2026-01-13
- Certified
- 2026-01-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.