MEDICARE: TESS C BATCHELDER CPNP-PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	APN.0996998-NP	CO

General Provider Information

NPI Number	:	1154083921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESS C BATCHELDER CPNP-PC

Provider Business Mailing Address
First Line	:	1619 N GREENWOOD ST STE 400
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1619 N GREENWOOD ST STE 400
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2658
Country	:	US
Telephone Number	:	719-583-2330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2021
Last Update Date	:	10/09/2021

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