Tessa Poulsen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1002 Issued in ID

Practice address

325 Martin St
Twin Falls, ID 83301-4563

Phone

(208) 734-0451

Fax

(208) 734-0452

NPI assigned

Oct 25, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Mrs. Tessa A Whiteley Former name

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Burley, ID
  • NPI 1033165550
  Medicare reassignment NPD
• River View Urgent Care & Medical Center Inc

  • Urgent Care Clinic/Center
  • Burley, ID
  • NPI 1790043693
  Medicare reassignment
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Twin Falls, ID
  • NPI 1235279217

  Physician Assistant

  NPD
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Kimberly, ID
  • NPI 1659946861
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481068800000",
    "number": "1386944304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 POMERELLE AVE",
            "address_2": "STE B",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182013",
            "telephone_number": "208-734-3312",
            "fax_number": "208-734-5036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 MARTIN ST",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833014563",
            "telephone_number": "208-734-0451",
            "fax_number": "208-734-0452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULSEN",
        "first_name": "TESSA",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-25",
        "last_updated": "2016-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA21275",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TESSA",
            "last_name": "WHITELEY",
            "middle_name": "A",
            "prefix": "MRS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Positive Connections Plus, LLC
• Positively Nourished LLC
• Alice Faye Potthast, M. ED., LMFT
• Corie J Poulsen, LCPC
• Jamie Poulsen, LMSW
• Alyson Povey, LMSW
• Elyse Marie Powderly, OTR/L
• Darin K Powell, D.O.
• Kimberli Anne Powell, LMSW
• Richard Anthony Michael Powell, APH,NMD,CAC,PHD

• Physician Assistant in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.