MEDICARE: TESSA LAVON PAYNE

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1275340747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESSA LAVON PAYNE

Provider Business Mailing Address
First Line	:	7210 S YALE AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-6319
Country	:	US
Telephone Number	:	918-998-8722
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 N 20TH ST
Second Line	:
City	:	COLLINSVILLE
State	:	OK
Zip	:	74021-1607
Country	:	US
Telephone Number	:	918-998-8722
Fax Number	:

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

Provider Enumeration Date	:	12/17/2024
Last Update Date	:	12/20/2024

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Directions to “ TESSA LAVON PAYNE ” Practice Location

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