Provider Demographics
NPI:1851575989
Name:ELMENDORF, SHEILA KAY (APRN-C)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:KAY
Last Name:ELMENDORF
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:MRS
Other - First Name:SHEILA
Other - Middle Name:HUGHES
Other - Last Name:ELMENDORF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN-C
Mailing Address - Street 1:2175 CHAMBLISS AVE NW
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3842
Mailing Address - Country:US
Mailing Address - Phone:423-472-1140
Mailing Address - Fax:423-339-2242
Practice Address - Street 1:2175 CHAMBLISS AVE NW
Practice Address - Street 2:SUITE D
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3842
Practice Address - Country:US
Practice Address - Phone:423-472-1140
Practice Address - Fax:423-339-2242
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005344363L00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN11976212OtherCAQH
TN1514544Medicaid
TN4234354OtherBLUE CROSS
TNAPN0000005344OtherADVANCED PRACTICE
TN1514544Medicaid