Provider Demographics
NPI:1699584052
Name:BAIR, TESSA BLAIRE (CRNP)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:BLAIRE
Last Name:BAIR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:BLAIRE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4601 WHITESBURG DR SE STE 201
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4601 WHITESBURG DR SE STE 201
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1678
Practice Address - Country:US
Practice Address - Phone:256-880-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-186792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty