Provider Demographics
NPI:1245593011
Name:BRASSEAL, TRESSIE J APPLEWHITE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:TRESSIE
Middle Name:J APPLEWHITE
Last Name:BRASSEAL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TRESSIE
Other - Middle Name:JAPPLEWHITE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-268-5680
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:415 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7246
Practice Address - Country:US
Practice Address - Phone:601-268-5680
Practice Address - Fax:601-579-5240
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS751483363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9156933OtherAETNA
MS12441370OtherCAQH ID #
MS01436898Medicaid
MS12441370OtherCAQH ID #