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General NPI Number Information
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NPI Number | 1558826719
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Entity Type | Individual
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Provider Name | ELLERY LAIRD PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 6216 HIGHLAND PLACE WAY STE 102
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City | KNOXVILLE
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State | TN
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Zip | 37919-4068
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Country | US
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Telephone | 865-888-9958
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Fax | 440-582-3171
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Provider Business Mailing Address
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Address Line | 524 N 5TH AVE
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City | ANN ARBOR
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State | MI
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Zip | 48104-1110
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Country | US
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Telephone | 616-403-1375
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601009995
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA56519
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA6499
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License Number State | TN
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