NICQUELETTE ELLISON
NPI 1912745472
Psychologist in Tyler, TX
About Nicquelette Ellison NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
NICQUELETTE ELLISON (NPI 1912745472) is an individual psychologist in Tyler, Texas and active in the NPI registry since July 2024. She has opted out of Medicare through January 13, 2028.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Opted out of Medicare
Nicquelette Ellison has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 13, 2026 through January 13, 2028.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Nicquelette Ellison's NPI number?
The NPI number for Nicquelette Ellison is 1912745472. It was assigned to this individual provider in the NPPES registry on July 18, 2024.
Where is Nicquelette Ellison located?
Nicquelette Ellison practices at 2830 W Grande Blvd Apt 3102, Tyler, TX 75703. The listed phone number is (813) 919-5860.
What is Nicquelette Ellison's specialty?
The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.
Is Nicquelette Ellison enrolled in Medicare?
No. Nicquelette Ellison has opted out of Medicare through January 13, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.
When was this NPI record last updated?
The NPPES record for Nicquelette Ellison was last updated on October 8, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.