Provider Demographics
NPI:1275299661
Name:NEMATI, SAMUEL JAMES (FNP)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JAMES
Last Name:NEMATI
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 MEDICAL DR STE 205
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5208
Mailing Address - Country:US
Mailing Address - Phone:903-291-6153
Mailing Address - Fax:
Practice Address - Street 1:802 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5153
Practice Address - Country:US
Practice Address - Phone:903-291-6153
Practice Address - Fax:903-232-8233
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX958871163WC0200X
TXF06240651363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine