Provider Demographics
NPI:1528134574
Name:PRITCHETT, ELIZABETH E (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:PRITCHETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 TINY TOWN RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-5809
Mailing Address - Country:US
Mailing Address - Phone:931-431-7580
Mailing Address - Fax:931-431-7583
Practice Address - Street 1:800 TINY TOWN RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-5809
Practice Address - Country:US
Practice Address - Phone:931-431-7580
Practice Address - Fax:931-431-7583
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000207012084P0800X, 2084P0804X
KY277702084P0800X, 2084P0804X
ARE-06992084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY64927957Medicaid
136961Medicare UPIN
4034083Medicare UPIN
KYKY64927957Medicaid
15-100360Medicare UPIN
TN3836149Medicare ID - Type UnspecifiedMEDICARE