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2403 Wooten Blvd Sw Suite E Wilson NC 27893-4463 | |
| (252) 291-1100 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 2403 Wooten Blvd Sw, Wilson, North Carolina |
| Authorized Official Name and Position | Eddie Stuart Tessnear (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 2522911100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2403 Wooten Blvd Sw Suite E Wilson NC 27893-4463 Ph: (252) 291-1100 | 2403 Wooten Blvd Sw Suite E Wilson NC 27893-4463 Ph: (252) 291-1100 |
| NPI Number | 1104044619 |
|---|---|
| Provider Enumeration Date | 04/22/2007 |
| Last Update Date | 01/24/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104044619 | NPI | - | NPPES |
| 0267L | Other | NC | BLUE CROSS BLUE SHIELD NC |
| 6005109 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 1506 (North Carolina) | Primary |
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