Provider Demographics
NPI:1386128189
Name:ROULSTON, TESSA ARNOLD (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TESSA
Middle Name:ARNOLD
Last Name:ROULSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:JEAN
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1190 GABLES DR APT 308
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4815
Mailing Address - Country:US
Mailing Address - Phone:423-956-0282
Mailing Address - Fax:
Practice Address - Street 1:1901 TATE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1109
Practice Address - Country:US
Practice Address - Phone:434-200-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant