Healthcare Provider Details

I. General information

NPI: 1457855637
Provider Name (Legal Business Name): LA'MESA HUNTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LA'MESA SNOWDEN

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E DAWSON ST
TYLER TX
75701-2036
US

IV. Provider business mailing address

800 E DAWSON ST
TYLER TX
75701-2036
US

V. Phone/Fax

Practice location:
  • Phone: 903-606-7264
  • Fax:
Mailing address:
  • Phone: 903-606-7264
  • Fax: 903-525-1254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP137081
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP137081
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: