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

Kenneth Robert Ellison, PA

Individual provider Medical Physician Assistant · NPI 1831122803

Kenneth Robert Ellison, PA is a Physician Assistant in Fort Walton Beach, Florida. Qualified in 2002, 24 years ago. Practices with White-Wilson Medical Center PA, a 47-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Florida.

Years since qualifying
24
Licensed in
FL
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1032 Mar Walt Dr Ste 250
Fort Walton Beach, FL 32547-6661
Phone: (850) 863-3463
Fax: (850) 315-6051
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 9106823 (FL)

Record details

NPI number1831122803
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedJuly 10, 2006
Last updated in NPPESJanuary 14, 2022

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice White-Wilson Medical Center Pa — 47 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

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