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General NPI Number Information
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NPI Number | 1275299661
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Entity Type | Individual
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Provider Name | SAMUEL JAMES NEMATI FNP
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Gender | Male
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 08/10/2026
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Provider Practice Location Address
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Address Line | 5174 FM 1252 W
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City | KILGORE
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State | TX
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Zip | 75662-1961
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Country | US
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Telephone | 903-986-1901
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Fax | 903-984-6151
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Provider Business Mailing Address
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Address Line | 5174 FM 1252 W
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City | KILGORE
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State | TX
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Zip | 75662-1961
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Country | US
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Telephone | 903-986-1901
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Fax | 903-984-6151
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 958871
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | F06240651
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License Number State | TX
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