Provider Demographics
NPI:1417787813
Name:BHATTI, ALECIA L (PA)
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:L
Last Name:BHATTI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALECIA
Other - Middle Name:
Other - Last Name:BEIMBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5754
Mailing Address - Country:US
Mailing Address - Phone:901-725-8347
Mailing Address - Fax:901-259-7637
Practice Address - Street 1:6286 BRIARCREST AVE # SUIE200
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4023
Practice Address - Country:US
Practice Address - Phone:901-259-1600
Practice Address - Fax:901-259-1698
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6261363A00000X
MSPA00848363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant