Provider Demographics
NPI:1245031772
Name:THACKREY, CONTESSA ELISAR (PA-C)
Entity type:Individual
Prefix:
First Name:CONTESSA
Middle Name:ELISAR
Last Name:THACKREY
Suffix:
Gender:
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:PSC 411 BOX 3523
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112-0036
Mailing Address - Country:US
Mailing Address - Phone:480-559-1030
Mailing Address - Fax:
Practice Address - Street 1:PSC 411 BOX 3523
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112-0036
Practice Address - Country:US
Practice Address - Phone:480-559-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant