Provider Demographics
NPI:1487193033
Name:GOSSETT, SAVANNAH (FNP-C)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:GOSSETT
Suffix:
Gender:F
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:PO BOX 51570
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-1570
Mailing Address - Country:US
Mailing Address - Phone:806-468-4350
Mailing Address - Fax:806-468-4351
Practice Address - Street 1:1901 MEDI PARK DR STE 2001
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-468-4350
Practice Address - Fax:806-468-4351
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX382731301Medicaid