Provider Demographics
NPI:1700331147
Name:PELTON, ELISSA RAINER (PA-C)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:RAINER
Last Name:PELTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELISSA
Other - Middle Name:JO
Other - Last Name:RAINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3791
Mailing Address - Country:US
Mailing Address - Phone:615-469-1065
Mailing Address - Fax:
Practice Address - Street 1:615 MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3603
Practice Address - Country:US
Practice Address - Phone:615-469-1065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1170363A00000X
363A00000X
TN3952363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant