Betty Jo Ellington, DNP, APRN, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Jefferson City, TN
NPI 1114909538 · NPPES record last updated Sep 10, 2019
Key facts
- NPI
- 1114909538
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- APN0000006086 (TN)
- Practice address
- 1413 Russell Ave
Jefferson City, TN 37760-2562 - Phone
- (865) 471-5525
- NPI assigned
- Nov 20, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APN0000006086 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| East Tennessee Vascular Center, PLLC | Past | Accepting new patients | |
| East Tennessee Clinic Corp | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | APN0000006086 | TN | Yes |
Addresses
Primary practice location
1413 Russell Ave
Jefferson City, TN 37760-2562
Mailing address
1413 Russell Ave
Jefferson City, TN 37760-2562
Phone (865) 471-5525
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200382097 | Other | TN | TAX I.D. |
| 1508879719 | Other | TN | GROUP NPI |
| 4075540 | Other | TN | BLUE CROSS BLUE SHIELD |
| 4155963 | Other | TN | BLUE CROSS BLUE SHIELD |
Other providers in Jefferson City, TN
- Jeremy Len Diamond
- James David Dolbow
- Dr. William B Harris Gynecology, PC
- Candice Durman
- John Duty
- Stephanie Ann Erickson
- Fnu Avinashsingh Eswarsingh
- Express Health Clinic Corporation
- Family Chiropractic Care Center PC
- Allison Renee Farris
All providers in Jefferson City, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.