Healthcare Provider Details

I. General information

NPI: 1568248367
Provider Name (Legal Business Name): TEMPLE PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 02/16/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 CANYON CREEK DR. SUITE 120
TEMPLE TX
76502-3545
US

IV. Provider business mailing address

903 CANYON CREEK DR. SUITE 120
TEMPLE TX
76502-3545
US

V. Phone/Fax

Practice location:
  • Phone: 512-971-2930
  • Fax: 512-582-8585
Mailing address:
  • Phone: 512-971-2930
  • Fax: 512-582-8585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA HARMON
Title or Position: OWNER
Credential: MSN, CPNP-PC
Phone: 512-971-2930