MEDICARE: ELISSA RAINER PELTON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1170	AL
2	363A00000X	Physician Assistant
3	363A00000X	Physician Assistant	3952	TN

General Provider Information

NPI Number	:	1700331147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISSA RAINER PELTON PA-C

Provider Business Mailing Address
First Line	:	901 WOODLAND ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-3791
Country	:	US
Telephone Number	:	615-469-1065
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 MAIN ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-3603
Country	:	US
Telephone Number	:	615-469-1065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2016
Last Update Date	:	07/07/2021

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Directions to “ ELISSA RAINER PELTON PA-C” Practice Location

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