1063080331 NPI number — MRS. TESS DOWDLE COOLEY PHYSICIAN ASSISTANT

Table of content: MRS. TESS DOWDLE COOLEY PHYSICIAN ASSISTANT (NPI 1063080331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063080331 NPI number — MRS. TESS DOWDLE COOLEY PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOLEY
Provider First Name:
TESS
Provider Middle Name:
DOWDLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOWDLE
Provider Other First Name:
TESS
Provider Other Middle Name:
JULIANNA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063080331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 W FERTITTA BLVD STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEESVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71446-4665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-238-0167
Provider Business Mailing Address Fax Number:
337-238-0574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W FERTITTA BLVD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71446-4665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-238-0167
Provider Business Practice Location Address Fax Number:
337-238-0574
Provider Enumeration Date:
06/14/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  326425 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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