Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nicolas Robert Ellsworth

Individual provider Physician Assistant · NPI 1477365823

Nicolas Robert Ellsworth is a Physician Assistant in Maryville, Tennessee. Qualified in 2024, 2 years ago. Practices as a sole proprietor.

Years since qualifying
2
In the registry since
2025
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Practice location Address checks out

1610 Madison Ave
Maryville, TN 37804-2931
Phone: (480) 322-5741
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1477365823
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJanuary 23, 2025
Last updated in NPPESJanuary 23, 2025
Certification dateJanuary 23, 2025
Mailing address1610 Madison Ave, Maryville, TN 37804-2931

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

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