Provider Demographics
NPI:1760020606
Name:DE JESUS, TESS VISITACION (MSN RN AGACNP)
Entity Type:Individual
Prefix:
First Name:TESS
Middle Name:VISITACION
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:MSN RN AGACNP
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 S 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4915
Mailing Address - Country:US
Mailing Address - Phone:918-683-0753
Mailing Address - Fax:918-683-5677
Practice Address - Street 1:350 S 40TH ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-4915
Practice Address - Country:US
Practice Address - Phone:918-683-0753
Practice Address - Fax:918-683-5677
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP144121363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty