Provider Demographics
NPI:1750658373
Name:KNOWLES, AMBER SLATER (CPNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:SLATER
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:NICOLE
Other - Last Name:SLATER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:PO BOX 66308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-6308
Mailing Address - Country:US
Mailing Address - Phone:832-548-5076
Mailing Address - Fax:713-523-4897
Practice Address - Street 1:9636 MESA DR
Practice Address - Street 2:(BUILDING 9618)
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77078-3024
Practice Address - Country:US
Practice Address - Phone:281-628-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX717891363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX741825Medicare Oscar/Certification