Healthcare Provider Details

I. General information

NPI: 1093453110
Provider Name (Legal Business Name): TESS BIERL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 HENDERSON DR
JACKSONVILLE NC
28546-5249
US

IV. Provider business mailing address

PO BOX 96191
CHARLOTTE NC
28296-6191
US

V. Phone/Fax

Practice location:
  • Phone: 770-962-3642
  • Fax: 770-962-3642
Mailing address:
  • Phone: 770-962-3642
  • Fax: 770-962-3643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16874
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number028228
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number028228
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: