Active NPI
Eddie Tessnear
- Psychologist
- Wilson, NC
National Provider Identifier
1104044619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1506
- Legal business name
- EDDIE TESSNEAR
- Practice address
- 2403 Wooten Blvd SW
Suite E
Wilson, NC 27893-4463 - Phone
- (252) 291-1100
- NPI assigned
- Apr 22, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Eddie Stuart Tessnear, PH.D.
- Title
- Licensed Psychologist
- Phone
- (252) 291-1100
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1506 | NC | Primary |
Addresses
Primary practice location
2403 Wooten Blvd SW
Suite E
Wilson, NC 27893-4463
Mailing address
2403 Wooten Blvd SW
Suite E
Wilson, NC 27893-4463
Phone (252) 291-1100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0267L | Other | NC | BLUE CROSS BLUE SHIELD NC |
| 6005109 | Medicaid | NC |
Other names 1
- Coastal Psychological Associates
National Provider Directory
National Provider DirectoryLocations
2403 Wooten Blvd SW
Ste E
Wilson, NC 27893
Phone (252) 291-1100
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Psychologist
- Wilson, NC
- NPI 1528186582
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177200000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1295827200000",
"number": "1104044619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2403 WOOTEN BLVD SW",
"address_2": "SUITE E",
"city": "WILSON",
"state": "NC",
"postal_code": "278934463",
"telephone_number": "252-291-1100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2403 WOOTEN BLVD SW",
"address_2": "SUITE E",
"city": "WILSON",
"state": "NC",
"postal_code": "278934463",
"telephone_number": "252-291-1100"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EDDIE TESSNEAR",
"organizational_subpart": "NO",
"enumeration_date": "2007-04-22",
"last_updated": "2011-01-24",
"status": "A",
"authorized_official_last_name": "TESSNEAR",
"authorized_official_first_name": "EDDIE",
"authorized_official_middle_name": "STUART",
"authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
"authorized_official_telephone_number": "252-291-1100",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PH.D."
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist",
"state": "NC",
"license": "1506",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD NC",
"identifier": "0267L",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6005109",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Coastal Psychological Associates",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Wilson, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.