Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ivan Elises, APRN-CNP

Individual provider Psychiatric/Mental Health Registered Nurse · NPI 1891352910

Ivan Elises, APRN-CNP is a Nurse Practitioner in Moraine, Ohio. Qualified in 2020, 6 years ago. Practices with Kettering Independent Medical Group Inc, a 700-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Ohio.

Years since qualifying
6
Licensed in
OH
In the registry since
2019
Specialties on file
2
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Practice location Address checks out

5348 Lamme Rd
Moraine, OH 45439-3215
Phone: (937) 534-4651
Fax: (937) 522-8799
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1411 N Fairfield Rd, Beavercreek, OH 45432-2637 — (937) 426-2686

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence APRN.CNP.0027227 (OH)
Psychiatric/Mental Health Registered Nurse Taxonomy 163WP0808X · Licence RN.367625 (OH)

Record details

NPI number1891352910
Entity typeIndividual (Type 1)
GenderMale
Credentials APRN-CNP
Sole proprietorNo
NPI enumeratedMay 23, 2019
Last updated in NPPESJanuary 12, 2021
Certification dateJanuary 12, 2021
Mailing address5348 Lamme Rd, Moraine, OH 45439-3215

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Kettering Independent Medical Group Inc — 700 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations5 on file with Medicare

Other providers in Moraine