Healthcare Provider Details

I. General information

NPI: 1063080331
Provider Name (Legal Business Name): TESS DOWDLE COOLEY PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TESS JULIANNA DOWDLE

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W FERTITTA BLVD STE 1
LEESVILLE LA
71446-4665
US

IV. Provider business mailing address

301 W FERTITTA BLVD STE 1
LEESVILLE LA
71446-4665
US

V. Phone/Fax

Practice location:
  • Phone: 337-238-0167
  • Fax: 337-238-0574
Mailing address:
  • Phone: 337-238-0167
  • Fax: 337-238-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number326425
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: