Individual
JESSICA MARIE ELLIS
Active
Individual
JESSICA MARIE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP-AC
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
252633
TN
363LA2100X
Acute Care Nurse Practitioner
Primary
37542
TN
363LP0200X
Pediatric Nurse Practitioner
37542
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7101028620
—
KY
05
—
Q098720
—
TN
Enumeration date
10/27/2022
Last updated
09/07/2025
Update your record
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