Provider Demographics
NPI:1093079279
Name:SAMPSON, TERRY (NP)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E COKE RD
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75494-3418
Mailing Address - Country:US
Mailing Address - Phone:903-763-6176
Mailing Address - Fax:
Practice Address - Street 1:600 E COKE RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-3418
Practice Address - Country:US
Practice Address - Phone:903-763-6176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily