Individual
TERRI SCAMARDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701
(903) 606-4262
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
451371
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP124266
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
339067605
—
TX
01
—
844222
MEDICARE
TX
01
—
852551
MEDICARE
TX
01
—
8LG044
BCBS
TX
01
—
P02352019
MEDICARE RAIL ROAD
TX
01
—
P02352024
MEDICARE RAIL ROAD
TX
Enumeration date
10/17/2013
Last updated
05/20/2022
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