Provider Demographics
NPI:1902347974
Name:RESZ, TAMMIE MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:MICHELLE
Last Name:RESZ
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 1:1101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CASSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65625-1118
Mailing Address - Country:US
Mailing Address - Phone:417-847-1111
Mailing Address - Fax:417-544-8660
Practice Address - Street 1:1101 MAIN ST
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65625-1118
Practice Address - Country:US
Practice Address - Phone:417-847-1111
Practice Address - Fax:417-544-8660
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017004884363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant