Healthcare Provider Details

I. General information

NPI: 1346871076
Provider Name (Legal Business Name): YAVAPAI PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 N WINDSONG DR
PRESCOTT VALLEY AZ
86314-1208
US

IV. Provider business mailing address

13702 E QUAIL CT
DEWEY AZ
86327-4494
US

V. Phone/Fax

Practice location:
  • Phone: 928-350-8780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SEAN TESSMAN
Title or Position: OWNER / MANAGER
Credential:
Phone: 928-458-3861