Healthcare Provider Details

I. General information

NPI: 1073977732
Provider Name (Legal Business Name): SAMANTHA JO WRIGHT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 ELM ST
PORTLAND TX
78374-1714
US

IV. Provider business mailing address

5950 SARATOGA BLVD
CORPUS CHRISTI TX
78414-4100
US

V. Phone/Fax

Practice location:
  • Phone: 361-977-2059
  • Fax: 361-977-2047
Mailing address:
  • Phone: 361-985-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP131228
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: