MEDICARE: MELODY ELLIS

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	41531	TN

General Provider Information

NPI Number	:	1780532457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODY ELLIS

Provider Business Mailing Address
First Line	:	1220 RIVERBEND DR APT 107
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-4094
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 N EASTMAN RD STE 130
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-2385
Country	:	US
Telephone Number	:	423-915-6765
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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Directions to “ MELODY ELLIS ” Practice Location

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