Provider Demographics
NPI:1548728256
Name:REXROAD, TESSA LYN (APRN, CNP)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:LYN
Last Name:REXROAD
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 B CR 1150 N
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:IL
Mailing Address - Zip Code:61849
Mailing Address - Country:US
Mailing Address - Phone:217-714-9871
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2529
Practice Address - Country:US
Practice Address - Phone:217-383-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.018952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine