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NPI Code Detail

MEDICARE: JOHN L ELLIOTT FNP-BC

MEDICARE: JOHN L ELLIOTT FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN192497TN
2146L00000XParamedicEMT16137TN
3363LF0000XFamily Nurse PractitionerAPN20804TN

General Provider Information

NPI Number : 1205293198
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN L ELLIOTT FNP-BC
Provider Business Mailing Address
First Line : 1021 W OAKLAND AVE STE 310
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-2192
Country : US
Telephone Number : 423-302-6565
Fax Number :
Provider Business Practice Location Address
First Line : 1420 TUSCULUM BLVD
Second Line :
City : GREENEVILLE
State : TN
Zip : 37745-4279
Country : US
Telephone Number : 423-787-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2016
Last Update Date : 05/12/2026

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