Healthcare Provider Details

I. General information

NPI: 1942114897
Provider Name (Legal Business Name): TESSA SIMMERS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 VICTORIA ROSE LN S
FARGO ND
58104-6816
US

IV. Provider business mailing address

2209 VICTORIA ROSE LN S
FARGO ND
58104-6816
US

V. Phone/Fax

Practice location:
  • Phone: 651-402-3541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1433
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: