Individual
MS. JANICE A SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, FNP
Contact information
Practice address
5002 COWHORN CREEK RD, TEXARKANA, TX 75503-9766
(903) 614-3000
(903) 614-3525
Mailing address
5002 COWHORN CREEK RD, TEXARKANA, TX 75503-9766
(903) 614-3000
(903) 614-3525
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
A01558
AR
363L00000X
Nurse Practitioner
Primary
A01558
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155665758
—
AR
01
—
8N7205
BLUE CROSS BLUE SHIELD
TX
Enumeration date
01/10/2006
Last updated
06/06/2013
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