Provider Demographics
NPI:1578012282
Name:HILL, TESSA LYNN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:LYNN
Last Name:HILL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:LYNN
Other - Last Name:NATIONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:817 MT. AUBURN ROAD #100
Mailing Address - Street 2:SOUTHEAST PRIMARY CARE
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-6392
Mailing Address - Country:US
Mailing Address - Phone:573-519-4500
Mailing Address - Fax:
Practice Address - Street 1:817 S MOUNT AUBURN RD # 100
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6383
Practice Address - Country:US
Practice Address - Phone:573-519-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008020328163W00000X
MO1000991479163WC0200X
MO2016027441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine