Individual provider Active NPI

Raissa Ameh, WHNP, MSN

  • Women's Health Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1174969893
Registry record updated May 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
2371 Issued in TX
Practice address
649 S Broadway Ave
Ste. 2
Tyler, TX 75701-1677
Phone
(903) 939-2273
Fax
(903) 581-2137
NPI assigned
May 21, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 2371 TX Primary

Addresses

Primary practice location

649 S Broadway Ave
Ste. 2
Tyler, TX 75701-1677

Mailing address

4055 Hogan Dr
#1409
Tyler, TX 75709-6930

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
2371TXMDDental Hygienist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369094400000",
    "number": "1174969893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4055 HOGAN DR",
            "address_2": "#1409",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757096930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "649 S BROADWAY AVE",
            "address_2": "STE. 2",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011677",
            "telephone_number": "903-939-2273",
            "fax_number": "903-581-2137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMEH",
        "first_name": "RAISSA",
        "credential": "WHNP, MSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-21",
        "last_updated": "2013-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "TX",
            "license": "2371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.