Provider Demographics
NPI:1073774196
Name:JESSUP, TEMA LYNN (DO)
Entity type:Individual
Prefix:
First Name:TEMA
Middle Name:LYNN
Last Name:JESSUP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TEMA
Other - Middle Name:LYNN
Other - Last Name:BASSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-983-6027
Mailing Address - Fax:208-983-1824
Practice Address - Street 1:701 LEWISTON ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:ID
Practice Address - Zip Code:83522-9750
Practice Address - Country:US
Practice Address - Phone:208-962-3251
Practice Address - Fax:208-962-2313
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMR-0990207Q00000X
IDO-0546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808082400Medicaid