Provider Demographics
NPI:1194492124
Name:LE, SAMANTHA (APRN CPNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:APRN CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12406 S SHADOW COVE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-5655
Mailing Address - Country:US
Mailing Address - Phone:281-730-9446
Mailing Address - Fax:
Practice Address - Street 1:1919 S BRAESWOOD BLVD STE 5330
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4466
Practice Address - Country:US
Practice Address - Phone:832-827-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1022613363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics