Provider Demographics
NPI:1649000332
Name:DUET, ALLY ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:ALLY
Middle Name:ELIZABETH
Last Name:DUET
Suffix:
Gender:F
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 1:1009 BENIGNO LN
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-1602
Mailing Address - Country:US
Mailing Address - Phone:785-492-0915
Mailing Address - Fax:
Practice Address - Street 1:1009 BENIGNO LN
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-1602
Practice Address - Country:US
Practice Address - Phone:228-467-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00865363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant