Provider Demographics
NPI:1184484123
Name:FAIN, TESSA (PA)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:FAIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 S CAMINO DEL RIO STE B
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-6853
Mailing Address - Country:US
Mailing Address - Phone:970-247-1970
Mailing Address - Fax:
Practice Address - Street 1:523 S CAMINO DEL RIO STE B
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6853
Practice Address - Country:US
Practice Address - Phone:970-247-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPENDING207P00000X
COPA.0008767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine