MEDICARE: ADDISALEM TESMAMA NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0034048	OH
2	363LF0000X	Family Nurse Practitioner	4006538	KY

General Provider Information

NPI Number	:	1205514007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADDISALEM TESMAMA NP

Provider Business Mailing Address
First Line	:	4055 VALLEY VIEW LN, DALLAS, TX 75244
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5071
Country	:	US
Telephone Number	:	855-984-5121
Fax Number	:

Provider Business Practice Location Address
First Line	:	8230 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2200
Country	:	US
Telephone Number	:	513-891-1127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2023
Last Update Date	:	07/11/2023

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