Provider Demographics
NPI:1386390268
Name:FARNHAM, TESSA (PA-C)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:FARNHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:
Other - Last Name:STOLTENBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1625 N 205TH ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4885
Practice Address - Country:US
Practice Address - Phone:402-717-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2737363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant