Individual
AMANDA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
880 RUTLEDGE PIKE, BLAINE, TN 37709-2317
(865) 933-4110
(865) 933-4729
Mailing address
1923 SULPHUR SPRINGS RD, MORRISTOWN, TN 37813-5654
(423) 312-8165
(423) 714-2355
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
RN88608
NV
363AM0700X
Medical Physician Assistant
Primary
6356
TN
363AM0700X
Medical Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/06/2023
Last updated
07/25/2025
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