Healthcare Provider Details

I. General information

NPI: 1700011939
Provider Name (Legal Business Name): AMBER ELIZABETH HIGH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMBER ELIZABETH THOMPSON

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD STE 2300
GALVESTON TX
77555-2934
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-2934
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-1211
  • Fax: 409-772-1224
Mailing address:
  • Phone: 409-747-6240
  • Fax: 713-790-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number080611
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP117937
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: