Provider Demographics
NPI:1558895474
Name:HANDY, TESSIE RENEE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:TESSIE
Middle Name:RENEE
Last Name:HANDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 RICE RD APT 26D
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-3019
Mailing Address - Country:US
Mailing Address - Phone:662-809-8843
Mailing Address - Fax:
Practice Address - Street 1:6501 DOGWOOD VIEW PKWY STE A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213
Practice Address - Country:US
Practice Address - Phone:601-899-3340
Practice Address - Fax:601-899-3343
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110327363A00000X, 363AM0700X
MSPA00328363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPA00328OtherMISSISSIPPI STATE DOH LICENSE
FL020748200Medicaid
FLPA9110327OtherFLORIDA STATE DOH LICENSE