Provider Demographics
NPI:1215949300
Name:RUSSELL, HELA E (APN)
Entity type:Individual
Prefix:
First Name:HELA
Middle Name:E
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 W ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3728
Mailing Address - Country:US
Mailing Address - Phone:423-581-8844
Mailing Address - Fax:423-318-3050
Practice Address - Street 1:1329 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3728
Practice Address - Country:US
Practice Address - Phone:423-581-8844
Practice Address - Fax:423-318-3050
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8453363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP95479Medicare UPIN
TN3499816Medicare ID - Type Unspecified