Provider Demographics
NPI:1346994241
Name:YATES, SAMIRA GHANBAR
Entity Type:Individual
Prefix:
First Name:SAMIRA
Middle Name:GHANBAR
Last Name:YATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21501 KINGDOM EDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2084
Mailing Address - Country:US
Mailing Address - Phone:281-716-2092
Mailing Address - Fax:
Practice Address - Street 1:22704 LOOP 494
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2853
Practice Address - Country:US
Practice Address - Phone:832-583-7264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily