NPIMap

Individual provider Active NPI

Heather Renee Ellis, PA-C

  • Physician Assistant
  • Bristol, TN
National Provider Identifier
1356026157
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5557 Issued in TN
Practice address
1 Medical Park Blvd
Bristol, TN 37620-7430
Phone
(423) 844-1121
NPI assigned
Jun 19, 2023
Last updated
Oct 14, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5557 TN Primary

Addresses

Primary practice location

1 Medical Park Blvd
Bristol, TN 37620-7430

Mailing address

1021 W Oakland Ave Ste 310
Johnson City, TN 37604-2192
Phone (423) 952-2111

Other practice location 1

800 S Mohawk Dr Ste C
Erwin, TN 37650-2124
Phone (423) 735-4750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230906001027 TN Practitioner - Physician Assistant 1557724721 Reassigns benefits to 4 organizations
I20260609004113 VA Practitioner - Physician Assistant 1557724721 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

200 Corporate Blvd
Lafayette, LA 70508-3844

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5557TNMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmont Medical Associates, Inc. CurrentSince Oct 1, 2023 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince Oct 1, 2023 Accepting new patients
Steele Creek Physician Services PC Physician Assistant CurrentSince Oct 1, 2025 Accepting new patients
Wellmont Health System Current Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Oct 1, 2025 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Oct 1, 2025 Accepting new patients

Locations

200 Corporate Blvd
Lafayette, LA 70508

1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451

1497 W Elk Ave
Ste 20
Elizabethton, TN 37643
Phone (423) 547-7380

800 S Mohawk Dr
Ste C
Erwin, TN 37650
Phone (423) 330-6177

1019 W Oakland Ave
Ste 1
Johnson City, TN 37604
Phone (423) 915-5000

1021 W Oakland Ave
Ste 310
Johnson City, TN 37604
Phone (423) 302-6565

400 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 431-1310

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

1990 Holton Ave E
Big Stone Gap, VA 24219
Phone (276) 523-3111

127 Health Care Dr
Pennington Gap, VA 24277
Phone (276) 299-5000

Interoperability endpoints

  • Direct secure messaging: hellis294810@balladhealth.medalliesdirect.net

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760400000000",
    "number": "1356026157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE STE 310",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042192",
            "telephone_number": "423-952-2111",
            "fax_number": "423-282-1657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK BLVD",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376207430",
            "telephone_number": "423-844-1121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 S Mohawk Dr Ste C",
            "address_purpose": "LOCATION",
            "city": "Erwin",
            "state": "TN",
            "postal_code": "376502124",
            "country_code": "US",
            "telephone_number": "423-735-4750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "HEATHER",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-19",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "5557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, TN

Sources for this page

Verify at the official NPI Registry.