Individual
STEFANI ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
1025 EXECUTIVE PARK BLVD, KINGSPORT, TN 37660-4620
(423) 915-6284
Mailing address
3833 CIMARRON DR, KINGSPORT, TN 37664-3917
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
26239
TN
Other
Enumeration date
07/22/2019
Last updated
09/01/2020
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