Provider Demographics
NPI:1457336265
Name:SPEAKER, MARIELLEN ANGELA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIELLEN
Middle Name:ANGELA
Last Name:SPEAKER
Suffix:
Gender:F
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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-606-6400
Mailing Address - Fax:903-606-1522
Practice Address - Street 1:214 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8131
Practice Address - Country:US
Practice Address - Phone:903-593-1892
Practice Address - Fax:903-533-1776
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP113975363L00000X, 363LF0000X
TX674802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX839N08OtherBCBS
TX280078101Medicaid
TX280078102Medicaid
TXP00933606OtherMEDICARE RR
1457336265OtherNPI
TXTIN PLUS 010OtherTRICARE
TXP00933606OtherMEDICARE RR
TX280078102Medicaid