=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093679524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE LYNN ELLIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2025
-----------------------------------------------------
Last Update Date | 12/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 915 TATE BLVD SE STE 182
-----------------------------------------------------
City | HICKORY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28602-4042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-569-2880
-----------------------------------------------------
Fax | 828-569-1565
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 915 TATE BLVD SE STE 182
-----------------------------------------------------
City | HICKORY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28602-4042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-569-2880
-----------------------------------------------------
Fax | 828-569-1565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | F11250688
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | F11250688
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------