Provider Demographics
NPI:1841220852
Name:FAYSAL, SAMER C (FNP)
Entity Type:Individual
Prefix:
First Name:SAMER
Middle Name:C
Last Name:FAYSAL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33615 WINDCREST ESTATES BLVD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4726
Mailing Address - Country:US
Mailing Address - Phone:936-756-1651
Mailing Address - Fax:866-936-4875
Practice Address - Street 1:117 VISION PARK BLVD
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384
Practice Address - Country:US
Practice Address - Phone:936-443-8460
Practice Address - Fax:866-936-4875
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX8953111N00000X
TX798026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX647992OtherUHC
TX7788404OtherAETNA
TX606347OtherBCBS
U95229Medicare UPIN
TX7788404OtherAETNA
TX647992OtherUHC