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Individual

DR. BETTY JO ELLINGTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DNP, APRN, FNP-BC

Contact information

Practice address
1413 RUSSELL AVE, JEFFERSON CITY, TN 37760-2562
(865) 471-5525
Mailing address
1413 RUSSELL AVE, JEFFERSON CITY, TN 37760-2562
(865) 471-5525

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN0000006086
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1508879719
GROUP NPI
TN
01
200382097
TAX I.D.
TN
01
4075540
BLUE CROSS BLUE SHIELD
TN
01
4155963
BLUE CROSS BLUE SHIELD
TN
Enumeration date
11/20/2005
Last updated
09/10/2019
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