Organization
PEDIATRIC ASSOCIATES OF WEST TENNESSEE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE L ELLERBROOK (OWNER)
(731) 285-4111
Entity
Organization
Contact information
Practice address
1501 BRAYTON AVE, DYERSBURG, TN 38024-3158
(731) 285-4111
Mailing address
1501 BRAYTON AVE, DYERSBURG, TN 38024-3158
(731) 285-4111
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
TN
363LP0200X
Pediatric Nurse Practitioner
0000014756
TN
Other
Enumeration date
05/12/2016
Last updated
05/14/2025
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