Provider Demographics
NPI:1124592357
Name:SHIKESSO, TESHOME (NP PSYCH/MENTAL HEAL)
Entity Type:Individual
Prefix:
First Name:TESHOME
Middle Name:
Last Name:SHIKESSO
Suffix:
Gender:M
Credentials:NP PSYCH/MENTAL HEAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6C W INTERCITY AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-2730
Mailing Address - Country:US
Mailing Address - Phone:206-854-0329
Mailing Address - Fax:
Practice Address - Street 1:3955 156TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4831
Practice Address - Country:US
Practice Address - Phone:360-651-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61323848363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health