Healthcare Provider Details

I. General information

NPI: 1952650947
Provider Name (Legal Business Name): SAMI MALAE HARRIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 STATE HIGHWAY 31 E
CHANDLER TX
75758-2376
US

IV. Provider business mailing address

901 TURTLE CREEK DR
TYLER TX
75701-1947
US

V. Phone/Fax

Practice location:
  • Phone: 903-849-3862
  • Fax: 903-849-4965
Mailing address:
  • Phone: 903-596-3651
  • Fax: 903-594-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number715690
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: