Provider Demographics
NPI:1356636476
Name:CAMARA, SOUMAILA
Entity Type:Individual
Prefix:
First Name:SOUMAILA
Middle Name:
Last Name:CAMARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4146 S WEBBER DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9415
Mailing Address - Country:US
Mailing Address - Phone:832-288-1630
Mailing Address - Fax:
Practice Address - Street 1:2011 N COLLINS BLVD STE 607
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2636
Practice Address - Country:US
Practice Address - Phone:833-258-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2022-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY643013163W00000X
TX1017352363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY643013OtherNEW YORK STATE EDUCATION DEPARTMENT