Provider Demographics
NPI:1518900596
Name:HARPER, SANDRA BOARDMAN (NP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:BOARDMAN
Last Name:HARPER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3500 HILLCREST DR
Mailing Address - Street 2:STE. 1
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3157
Mailing Address - Country:US
Mailing Address - Phone:888-624-6882
Mailing Address - Fax:888-395-9138
Practice Address - Street 1:506 MEDICAL CENTER BLVD
Practice Address - Street 2:STE. 304
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2826
Practice Address - Country:US
Practice Address - Phone:888-624-6882
Practice Address - Fax:888-395-9138
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX595011363L00000X
TXAP109254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041471603Medicaid
TXS75497Medicare UPIN
TX82N465Medicare PIN
TX041471603Medicaid
TX341602ZH6HMedicare PIN