Provider Demographics
NPI:1063080331
Name:COOLEY, TESS DOWDLE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:TESS
Middle Name:DOWDLE
Last Name:COOLEY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:TESS
Other - Middle Name:JULIANNA
Other - Last Name:DOWDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 W FERTITTA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4665
Mailing Address - Country:US
Mailing Address - Phone:337-238-0167
Mailing Address - Fax:337-238-0574
Practice Address - Street 1:301 W FERTITTA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4665
Practice Address - Country:US
Practice Address - Phone:337-238-0167
Practice Address - Fax:337-238-0574
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA326425363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant