Healthcare Provider Details

I. General information

NPI: 1205524915
Provider Name (Legal Business Name): TESSA TOLEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 S KANSAS EXPY STE B
SPRINGFIELD MO
65807-6989
US

IV. Provider business mailing address

PO BOX 7411626
CHICAGO IL
60674-5626
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-0269
  • Fax:
Mailing address:
  • Phone: 417-269-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2024032639
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: