Provider Demographics
NPI:1376114132
Name:NALL, TIMOTHY A (FNP-C)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:NALL
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5217 BRADLY LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-1568
Mailing Address - Country:US
Mailing Address - Phone:346-465-6189
Mailing Address - Fax:
Practice Address - Street 1:5217 BRADLY LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-1568
Practice Address - Country:US
Practice Address - Phone:346-465-6189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily