Healthcare Provider Details

I. General information

NPI: 1821351891
Provider Name (Legal Business Name): TESSA V VISSER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TESSA V BANDHAN MD

II. Dates (important events)

Enumeration Date: 06/24/2012
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 SAINT MARYS RD
JUNCTION CITY KS
66441-4176
US

IV. Provider business mailing address

1110 SAINT MARYS RD
JUNCTION CITY KS
66441-4176
US

V. Phone/Fax

Practice location:
  • Phone: 785-762-2585
  • Fax: 785-210-3382
Mailing address:
  • Phone: 785-762-2585
  • Fax: 785-210-3382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-40302
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: