Healthcare Provider Details

I. General information

NPI: 1134083082
Provider Name (Legal Business Name): TESSA JOHNSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14517 HASCALL ST
OMAHA NE
68144-5479
US

IV. Provider business mailing address

14517 HASCALL ST
OMAHA NE
68144-5479
US

V. Phone/Fax

Practice location:
  • Phone: 402-881-2225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: