Provider Demographics
NPI:1992004824
Name:ELLIOTT, AIMEE (NP)
Entity Type:Individual
Prefix:MS
First Name:AIMEE
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-5705
Mailing Address - Country:US
Mailing Address - Phone:423-979-0000
Mailing Address - Fax:423-979-6333
Practice Address - Street 1:630 ONEEGA LN
Practice Address - Street 2:SUITE A
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-2197
Practice Address - Country:US
Practice Address - Phone:423-735-5700
Practice Address - Fax:423-735-5723
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15675364SF0001X
NC5012449363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005680Medicaid
TNP00954810OtherRR MEDICARE
TN1524893Medicaid
VA1992004824Medicaid
VA1992004824Medicaid