Individual
GARY NEWTON ELLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, NP-C
Contact information
Practice address
1511 MAIN ST, KIMBALL, TN 37347-5551
(423) 837-6000
Mailing address
1511 MAIN ST, KIMBALL, TN 37347-5551
(423) 837-6000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN0000014743
TN
Other
Enumeration date
05/05/2010
Last updated
05/28/2010
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