=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497680300
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TESS JERABEK BSN, RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2026
-----------------------------------------------------
Last Update Date | 06/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1305 HOWARD AVE
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68873-1402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-754-4433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1720 15TH AVE
-----------------------------------------------------
City | FARWELL
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68838-1822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WS0200X
-----------------------------------------------------
Taxonomy Name | School Registered Nurse
-----------------------------------------------------
License Number | 87651
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------