Individual
MISS TESSIE RENEE HANDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6501 DOGWOOD VIEW PKWY STE A, JACKSON, MS 39213
(601) 899-3340
(601) 899-3343
Mailing address
715 RICE RD APT 26D, RIDGELAND, MS 39157-3019
(662) 809-8843
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00328
MS
363A00000X
Physician Assistant
PA9110327
FL
363AM0700X
Medical Physician Assistant
PA9110327
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020748200
—
FL
01
—
PA00328
MISSISSIPPI STATE DOH LICENSE
MS
01
—
PA9110327
FLORIDA STATE DOH LICENSE
FL
Enumeration date
04/18/2017
Last updated
10/10/2018
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