Healthcare Provider Details

I. General information

NPI: 1669642088
Provider Name (Legal Business Name): AMY ROBERTS HUFF FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 10/24/2023
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 S BROADWAY AVE
TYLER TX
75703-4413
US

IV. Provider business mailing address

7361 FLAT ROCK LN
TYLER TX
75703-7389
US

V. Phone/Fax

Practice location:
  • Phone: 903-579-2700
  • Fax:
Mailing address:
  • Phone: 903-566-7118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number510203
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: