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General NPI Number Information
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NPI Number | 1043008758
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Entity Type | Individual
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Provider Name | CRISSY N ELLIS MSN, CNM, CLC
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Gender | Female
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 07/12/2025
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Provider Practice Location Address
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Address Line | 490 ZIEGLER ROAD
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City | CHATTANOOGA
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State | TN
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Zip | 37421
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Country | US
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Telephone | 423-648-6020
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Fax |
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Provider Business Mailing Address
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Address Line | 116 COUNTY ROAD 244
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City | ATHENS
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State | TN
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Zip | 37303-7025
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Country | US
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Telephone | 423-506-1287
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WX0003X
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Taxonomy Name | Inpatient Obstetric Registered Nurse
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License Number | 164156
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 39133
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License Number State | TN
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