Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

NICQUELETTE ELLISON
NPI 1912745472
Psychologist - Clinical in Tyler, TX

Q: 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.

Q: What is Nicquelette Ellison's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: 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.

Active since July 18, 2024Opted out of Medicare · through Jan 13, 2028

2830 W GRANDE BLVD APT 3102, TYLER, TX 75703(813) 919-5860 Get Directions Write a Review

NPPES record last updated: October 19, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 8, 2025, Jul 18, 2024 (2 updates tracked since 2024).

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About Nicquelette Ellison NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICQUELETTE ELLISON (NPI 1912745472) is an individual clinical provider in Tyler, Texas, licensed in Texas (40960) and active in the NPI registry since July 2024. She has opted out of Medicare through January 13, 2028.

NPPES Registry Identity

NPI1912745472

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameNICQUELETTE ELLISON

Location Address2830 W GRANDE BLVD APT 3102Tyler, TX 75703-3392

Mailing Address2830 W Grande Blvd Apt 3102Tyler, TX 75703-3392 · (813) 919-5860

Phone(813) 919-5860

Sole ProprietorNo

Enumeration DateJuly 18, 2024

Last NPPES UpdateOctober 19, 20262 updates tracked since enumeration

NPPES CertifiedOctober 19, 2026

✔ NPI 1912745472 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in TX · 40960

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

2830 W GRANDE BLVD APT 3102, Tyler, TX 75703

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas, Moda Health Plan, Inc., Oscar Insurance Company and more.Insurance ›

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.

Opt-Out Effective DateJanuary 13, 2026

Opt-Out In Effect ThroughJanuary 13, 2028Opt-out affidavits renew automatically every two years unless cancelled

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, specializing in Clinical, with taxonomy code 103TC0700X.

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.

What insurance does Nicquelette Ellison accept?

Health plans from Blue Cross and Blue Shield of Texas, Moda Health Plan, Inc., Oscar Insurance Company and UnitedHealthcare list Nicquelette Ellison as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Nicquelette Ellison was last updated on October 19, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 days 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.