Provider Demographics
NPI:1992865505
Name:KADAVIL, TESSY (NP)
Entity Type:Individual
Prefix:MRS
First Name:TESSY
Middle Name:
Last Name:KADAVIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7713 HIGHLAND PARK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-5127
Mailing Address - Country:US
Mailing Address - Phone:210-274-5264
Mailing Address - Fax:866-722-3757
Practice Address - Street 1:7713 HIGHLAND PARK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-5127
Practice Address - Country:US
Practice Address - Phone:210-274-5264
Practice Address - Fax:866-722-3757
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX614956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161802702Medicaid
TX611716Medicare ID - Type Unspecified
TX161802702Medicaid