=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902787880
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TESSA MARIE KIRKLIN CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2025
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3175 PROFESSIONAL CT
-----------------------------------------------------
City | BAY CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48706-2823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-667-3377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 253 E SEBEWAING ST
-----------------------------------------------------
City | SEBEWAING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48759-1007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-834-8961
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | 4704342125
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------