Provider Demographics
NPI:1922494749
Name:ROUSSEAU, RHETT JOSEPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RHETT
Middle Name:JOSEPH
Last Name:ROUSSEAU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1429 BENJAMIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37876-5403
Mailing Address - Country:US
Mailing Address - Phone:865-579-0599
Mailing Address - Fax:865-609-0808
Practice Address - Street 1:10622 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4703
Practice Address - Country:US
Practice Address - Phone:865-579-0599
Practice Address - Fax:865-609-0808
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2762363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical