Ava Rose Dettore, PA is a medicare enrolled "Physician Assistant" in Red Bank, Tennessee. She graduated from nursing school in 2024 and has 1 years of diverse experience with area of expertise as Physician Assistant. She is a member of the group practice Fast Pace Medical Clinic Pllc and her current practice location is
4104 Dayton Blvd, Red Bank, Tennessee. You can reach out to her office (for appointments etc.) via phone at
(423) 499-7710.
Ava Rose Dettore is licensed to practice in Tennessee (license number 6179) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1295562106.
Provider's Profile
| Full Name | Ava Rose Dettore |
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| Gender | Female |
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| Speciality | Physician Assistant |
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| Experience | 1 Years |
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| Location | 4104 Dayton Blvd, Red Bank, Tennessee |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Ava Rose Dettore graduated from nursing school in 2024
NPI Data:
- NPI Number: 1295562106
- Provider Enumeration Date: 09/16/2024
- Last Update Date: 09/16/2024
Medicare PECOS Information:
- PECOS PAC ID: 2264967553
- Enrollment ID: I20241122003380
Medical Identifiers
Medical identifiers for Ava Rose Dettore such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1295562106 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363A00000X | Physician Assistant | 6179 (Tennessee) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Fast Pace Medical Clinic Pllc | 5395881841 | 680 |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ava Rose Dettore is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Ava Rose Dettore, PA
4104 Dayton Blvd,
Red Bank, TN 37415-7155
Ph: (423) 499-7710 | Ava Rose Dettore, PA
4104 Dayton Blvd,
Red Bank, TN 37415-7155
Ph: (423) 499-7710 |
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