Individual provider · NPI-1

Justin Michael Ellison

Nurse Practitioner · Chattanooga, TN

NPI number1245688928
StatusActive
Last updated in NPPESAug 27, 2026

Details

NPI
1245688928
Entity type
Individual (NPI-1)
Name
Justin Michael Ellison
Sex
Male
Sole proprietor
Yes
Enumeration date
Jun 2, 2016
Certification date
Aug 27, 2026
Last updated
Aug 27, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363L00000X Nurse PractitionerCP003314SDYes
163WR0006X Registered Nurse, Registered Nurse First Assistant31438TN
363L00000X Nurse Practitioner31438TN
163W00000X Registered Nurse9344794FL
363L00000X Nurse Practitioner60350NM
363L00000X Nurse PractitionerN360677930WA
163W00000X Registered Nurse196881TN

Practice location

1949 Gunbarrel Rd Ste 206
Chattanooga, TN 37421-7133

Phone 423-495-4349 · Fax 423-495-4934

Mailing address

800 Bradbury Dr Se Ste 116
Albuquerque, NM 87106-4310

Phone 505-272-1476

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