Provider Demographics
NPI:1720553167
Name:KINGSLAND, TESSA D (FNP)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:D
Last Name:KINGSLAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 ABBERLY LN
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-6240
Mailing Address - Country:US
Mailing Address - Phone:864-504-4888
Mailing Address - Fax:
Practice Address - Street 1:1295 OLD SPARTANBURG HWY
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-1820
Practice Address - Country:US
Practice Address - Phone:864-661-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22231363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily