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General NPI Number Information
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NPI Number | 1740816834
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Entity Type | Individual
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Provider Name | CHESSY MARIE MACDONALD PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 6000 W HIGHWAY 98
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City | PENSACOLA
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State | FL
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Zip | 32512-2419
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Country | US
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Telephone | 850-505-6069
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Fax |
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Provider Business Mailing Address
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Address Line | 14146 FOX HILL DR
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City | GULFPORT
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State | MS
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Zip | 39503-5392
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Country | US
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Telephone | 703-300-5569
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA00509
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License Number State | MS
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