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Individual

JUSTIN MICHAEL ELLISON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1949 GUNBARREL RD STE 206, CHATTANOOGA, TN 37421-7133
(423) 495-4349
(423) 495-4934
Mailing address
800 BRADBURY DR SE STE 116, ALBUQUERQUE, NM 87106-4310
(505) 272-1476

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
196881
TN
163W00000X
Registered Nurse
9344794
FL
163WR0006X
Registered Nurse First Assistant
31438
TN
363L00000X
Nurse Practitioner
31438
TN
363L00000X
Nurse Practitioner
60350
NM
363L00000X
Nurse Practitioner
Primary
CP003314
SD
363L00000X
Nurse Practitioner
N360677930
WA

Other

Enumeration date
06/02/2016
Last updated
03/17/2025
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