Provider Demographics
NPI:1801134259
Name:THEALL, AMBER MARIE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MARIE
Last Name:THEALL
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 1:9180 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-4521
Mailing Address - Country:US
Mailing Address - Phone:409-543-4431
Mailing Address - Fax:
Practice Address - Street 1:740 HOSPITAL DR
Practice Address - Street 2:SUITE 250
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4664
Practice Address - Country:US
Practice Address - Phone:409-212-1000
Practice Address - Fax:409-212-1003
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX737870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily