Provider Demographics
NPI:1164142071
Name:DIDIER, TESSA M
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:M
Last Name:DIDIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 JOHN WESLEY BLVD APT 172
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2294
Mailing Address - Country:US
Mailing Address - Phone:478-410-9232
Mailing Address - Fax:
Practice Address - Street 1:400 JOHN WESLEY BLVD APT 172
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2294
Practice Address - Country:US
Practice Address - Phone:478-410-9232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator