Provider Demographics
NPI:1568186542
Name:ELLIOTT, LILLIE GRACE (MSN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LILLIE
Middle Name:GRACE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BIG HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-5327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:308 8TH ST STE B
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-2228
Practice Address - Country:US
Practice Address - Phone:423-530-3703
Practice Address - Fax:423-500-7352
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN34360363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health