Healthcare Provider Details

I. General information

NPI: 1922528900
Provider Name (Legal Business Name): TESSA HOVENDEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W COWLES ST
FAIRBANKS AK
99701-5926
US

IV. Provider business mailing address

1717 W COWLES ST
FAIRBANKS AK
99701-5926
US

V. Phone/Fax

Practice location:
  • Phone: 907-451-6682
  • Fax:
Mailing address:
  • Phone: 907-451-6682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number94-09352
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: