Provider Demographics
NPI:1740816834
Name:MACDONALD, CHESSY MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CHESSY
Middle Name:MARIE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHESSY
Other - Middle Name:MARIE
Other - Last Name:DINTRUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:14146 FOX HILL DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-5392
Mailing Address - Country:US
Mailing Address - Phone:703-300-5569
Mailing Address - Fax:
Practice Address - Street 1:6000 W HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512-2419
Practice Address - Country:US
Practice Address - Phone:850-505-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00509363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant