Provider Demographics
NPI:1104459767
Name:HAMILTON, TESSA JANE (DNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:JANE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4718 S HILLHOUSE CV UNIT 103
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-4086
Mailing Address - Country:US
Mailing Address - Phone:801-872-3348
Mailing Address - Fax:801-823-0706
Practice Address - Street 1:850 E 300 S STE 6
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2332
Practice Address - Country:US
Practice Address - Phone:801-872-3348
Practice Address - Fax:801-823-0706
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9458849-3102163WP0808X
UT94588494405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health