Provider Demographics
NPI:1376268037
Name:SAM, BRIGHT
Entity Type:Individual
Prefix:
First Name:BRIGHT
Middle Name:
Last Name:SAM
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 1:422 LIPIZZAN LN
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-4657
Mailing Address - Country:US
Mailing Address - Phone:972-357-5944
Mailing Address - Fax:
Practice Address - Street 1:7225 E SOUTHGATE DR STE D
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2651
Practice Address - Country:US
Practice Address - Phone:916-912-4119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX833764163W00000X
CA95025460363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse