Provider Demographics
NPI:1699021709
Name:EKPETI, TAM (GNP)
Entity type:Individual
Prefix:MRS
First Name:TAM
Middle Name:
Last Name:EKPETI
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:TAMBARI
Other - Middle Name:
Other - Last Name:MATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10124 HAMMERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-5010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10124 HAMMERLY BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-5010
Practice Address - Country:US
Practice Address - Phone:713-335-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX558615363LG0600X
TXAP121828363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology