MEDICARE: TESSA LYNN HAYNES 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	0024178490	VA
2	207Q00000X	Family Medicine Physician	0024178490	VA

General Provider Information

NPI Number	:	1922643428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESSA LYNN HAYNES NP

Provider Business Mailing Address
First Line	:	213 S JEFFERSON ST STE 1006
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24011-1713
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18080 MAIN ST
Second Line	:
City	:	BUCHANAN
State	:	VA
Zip	:	24066-5482
Country	:	US
Telephone Number	:	540-254-1239
Fax Number	:

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

Provider Enumeration Date	:	11/08/2019
Last Update Date	:	10/21/2025

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