Provider Demographics
NPI:1881972727
Name:SOUTER, AMY B (FNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:SOUTER
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 1:13027 STATE HIGHWAY 155 S
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-6548
Mailing Address - Country:US
Mailing Address - Phone:903-839-1000
Mailing Address - Fax:903-839-4000
Practice Address - Street 1:403 STATE HIGHWAY 110 N
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-3109
Practice Address - Country:US
Practice Address - Phone:903-839-1000
Practice Address - Fax:903-839-4000
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX712711163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EM889OtherBCBSTX
TX1881972727OtherBCBSTX
TXP01436333OtherRR MEDICARE
1881972727OtherNPI
TX2867178-02Medicaid
TX1881972727OtherBCBSTX