Ellsworth, Kristen Wilson

Ellsworth, Kristen Wilson is an individual health care provider with primary practice located at 151 Adams Ln Suite 13, Mount Juliet TN 37122-3598. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Ellsworth, Kristen Wilson can be contacted via phone (615) 288-4087.

Contact Information

Primary practice address
151 Adams Ln Suite 13 Mount Juliet TN 37122-3598
Phone: (615) 288-4087
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 18503 Tennessee

Profile Details

NPI number 1669890927
LBN Legal business name Ellsworth, Kristen Wilson
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 3rd, 2014
Last updated May 16th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669890927 NPPES
Tennessee MEDICAID Q011560

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