Provider Demographics
NPI:1861845356
Name:BUISSON, BETHANY (PA-C)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:BUISSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3729 OLD CREEK CV
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-2496
Mailing Address - Country:US
Mailing Address - Phone:901-216-3576
Mailing Address - Fax:
Practice Address - Street 1:1920 KIRBY PKWY STE 202
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3697
Practice Address - Country:US
Practice Address - Phone:901-751-9997
Practice Address - Fax:901-751-1344
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant