Healthcare Provider Details

I. General information

NPI: 1639594773
Provider Name (Legal Business Name): TESSA CECILE PALMER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TESSA SMITH

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4778 S SCATTERFIELD RD
ANDERSON IN
46013
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 765-646-6331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71004834A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71004834A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: