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General NPI Number Information
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NPI Number | 1497317564
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Entity Type | Individual
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Provider Name | SAMANTHA REIS APRN, FNP-BC, CEN
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Gender | Female
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Dates
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Enumeration Date | 06/28/2019
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 5653 MCPHERSON BLVD
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City | FORT WORTH
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State | TX
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Zip | 76123-6023
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Country | US
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Telephone | 682-354-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 7801 COUNTY ROAD 915B
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City | JOSHUA
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State | TX
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Zip | 76058-2200
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Country | US
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Telephone | 817-907-4014
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | AP142039
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP142039
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License Number State | TX
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