Provider Demographics
NPI:1942767264
Name:BESSETTE, SIMON (PA-C)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:BESSETTE
Suffix:
Gender:M
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 1:421 OLD RICEVILLE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3074
Mailing Address - Country:US
Mailing Address - Phone:423-744-8755
Mailing Address - Fax:423-744-8568
Practice Address - Street 1:421 OLD RICEVILLE RD STE 2
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3074
Practice Address - Country:US
Practice Address - Phone:423-744-8755
Practice Address - Fax:423-744-8568
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3808363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3808OtherLICENCE TO PRACTICE
1161064OtherNCCPA CERTIFICATION NUMBER