Healthcare Provider Details

I. General information

NPI: 1497665012
Provider Name (Legal Business Name): TESSA LUE PATRICK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 N EWING ST
SEYMOUR IN
47274-3480
US

IV. Provider business mailing address

1957 N COUNTY ROAD 400 E
SEYMOUR IN
47274-8613
US

V. Phone/Fax

Practice location:
  • Phone: 812-524-3333
  • Fax:
Mailing address:
  • Phone: 812-498-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28197096A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: