Provider Demographics
NPI:1437030616
Name:ELLISON, JEANETTE LEANN (PMHNP-C)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:LEANN
Last Name:ELLISON
Suffix:
Gender:F
Credentials:PMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 E DONNER DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6069
Mailing Address - Country:US
Mailing Address - Phone:602-448-8146
Mailing Address - Fax:
Practice Address - Street 1:2824 E DONNER DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6069
Practice Address - Country:US
Practice Address - Phone:602-448-8146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ254185363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty