Healthcare Provider Details

I. General information

NPI: 1043008758
Provider Name (Legal Business Name): CRISSY N ELLIS MSN, CNM, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 07/12/2025
Certification Date: 07/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 ZIEGLER ROAD
CHATTANOOGA TN
37421
US

IV. Provider business mailing address

116 COUNTY ROAD 244
ATHENS TN
37303-7025
US

V. Phone/Fax

Practice location:
  • Phone: 423-648-6020
  • Fax:
Mailing address:
  • Phone: 423-506-1287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number164156
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number39133
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: