Provider Demographics
NPI:1851859185
Name:LINN, TESSA RANAE
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:RANAE
Last Name:LINN
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 1:21918 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-3218
Mailing Address - Country:US
Mailing Address - Phone:214-674-8939
Mailing Address - Fax:
Practice Address - Street 1:21918 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-3218
Practice Address - Country:US
Practice Address - Phone:214-674-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist