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General NPI Number Information
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NPI Number | 1447182878
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Entity Type | Organization
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Legal Business Name | ELLIS PSYCHIATRY, LLC
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/01/2026
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Provider Practice Location Address
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Address Line | 1880 N EASTMAN RD STE 130
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City | KINGSPORT
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State | TN
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Zip | 37664-2385
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Country | US
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Telephone | 423-915-6765
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Fax | 205-880-9514
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Provider Business Mailing Address
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Address Line | 3833 CIMARRON DR
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City | KINGSPORT
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State | TN
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Zip | 37664-3917
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Country | US
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Telephone | 423-915-6284
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER, OWNER
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Name | STEFANI ELLIS
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Credential | PMHNP-BC
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Telephone | 423-915-6284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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