Healthcare Provider Details

I. General information

NPI: 1497302269
Provider Name (Legal Business Name): TESSA LEE JAMESON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 04/23/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20200 54TH AVE W
LYNNWOOD WA
98036-6389
US

IV. Provider business mailing address

20200 54TH AVE W
LYNNWOOD WA
98036-6389
US

V. Phone/Fax

Practice location:
  • Phone: 425-672-6400
  • Fax: 425-672-6518
Mailing address:
  • Phone: 425-672-6400
  • Fax: 425-672-6518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61114548
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: