Provider Demographics
NPI:1972718468
Name:MCELYEA, HEATHER LEANN
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:LEANN
Last Name:MCELYEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 WHISPERING PINES RD
Mailing Address - Street 2:
Mailing Address - City:UNICOI
Mailing Address - State:TN
Mailing Address - Zip Code:37692-6619
Mailing Address - Country:US
Mailing Address - Phone:423-279-2653
Mailing Address - Fax:423-279-2727
Practice Address - Street 1:154 BLOUNTVILLE BYPASS
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617
Practice Address - Country:US
Practice Address - Phone:423-279-2653
Practice Address - Fax:423-279-2727
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB58933Medicare UPIN
TN3170197Medicare ID - Type UnspecifiedMEDICARE NUMBER FOR BLOUN