Provider Demographics
NPI:1629216817
Name:CASSELL, BRIDGETTE E (MHS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:E
Last Name:CASSELL
Suffix:
Gender:F
Credentials:MHS, PA-C
Other - Prefix:MS
Other - First Name:BRIDGETTE
Other - Middle Name:CECILE
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS, PA-C
Mailing Address - Street 1:1819 CLINCH AVENUE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2435
Mailing Address - Country:US
Mailing Address - Phone:865-546-5111
Mailing Address - Fax:865-541-4018
Practice Address - Street 1:1819 CLINCH AVENUE
Practice Address - Street 2:SUITE 108
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2435
Practice Address - Country:US
Practice Address - Phone:865-546-5111
Practice Address - Fax:865-541-4018
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1699363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I977426Medicare PIN