Healthcare Provider Details

I. General information

NPI: 1740657162
Provider Name (Legal Business Name): JESSICA SEAY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 CRESTHAVEN RD STE 300
MEMPHIS TN
38119-0809
US

IV. Provider business mailing address

6074 APPLE TREE DR STE 10
MEMPHIS TN
38115-0300
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-0024
  • Fax: 901-683-0086
Mailing address:
  • Phone: 901-922-5951
  • Fax: 901-922-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2838
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: