Provider Demographics
NPI:1750111373
Name:RAYNE, TESSA JEANNE (PA-C)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:JEANNE
Last Name:RAYNE
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 1:600 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HERTFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27944-1205
Mailing Address - Country:US
Mailing Address - Phone:715-307-4662
Mailing Address - Fax:
Practice Address - Street 1:600 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:HERTFORD
Practice Address - State:NC
Practice Address - Zip Code:27944-1205
Practice Address - Country:US
Practice Address - Phone:252-426-5711
Practice Address - Fax:252-426-1999
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant