Healthcare Provider Details

I. General information

NPI: 1063200137
Provider Name (Legal Business Name): TEXAS A&M UNIVERSITY SYSTEM HEALTH SCIENCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8447 JOHN SHARP PKWY
BRYAN TX
77807-1552
US

IV. Provider business mailing address

8447 JOHN SHARP PKWY
BRYAN TX
77807-1552
US

V. Phone/Fax

Practice location:
  • Phone: 979-436-0587
  • Fax: 979-436-0046
Mailing address:
  • Phone: 979-436-0582
  • Fax: 979-436-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROBIN FULLER
Title or Position: EXECUTIVE DIRECTOR OF FINANCE
Credential:
Phone: 979-436-0398