Individual provider · Type 1 NPI

Jared Michael Ellis, LPN

Licensed Practical Nurse · Charlotte, NC

NPI number 1336077205 Active

Practice location

10660 Park Rd Ste 3400
Charlotte, NC 28210-8461

Call (704) 667-3840 Map

Mailing address

716 Cody Ct
Fort Mill, SC 29715-7092

Specialties and licenses

TaxonomyCodeLicense
Licensed Practical Nurse Primary 164W00000X57164 (SC)

Licensed Practical Nurse: An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

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About NPI 1336077205

Jared Michael Ellis, LPN's National Provider Identifier is 1336077205, issued on May 11, 2026. The primary taxonomy on file is Licensed Practical Nurse (164W00000X), and the practice location is in Charlotte, NC. The record was last updated on May 11, 2026.