Provider Demographics
NPI:1497010151
Name:RUSSELL, TIMI RENEE (CSFA, LSA)
Entity type:Individual
Prefix:MS
First Name:TIMI
Middle Name:RENEE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:CSFA, LSA
Other - Prefix:MS
Other - First Name:TIMI
Other - Middle Name:
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSA
Mailing Address - Street 1:14826 BEECHMOOR DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-3304
Mailing Address - Country:US
Mailing Address - Phone:713-705-7953
Mailing Address - Fax:832-478-9266
Practice Address - Street 1:14826 BEECHMOOR DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-3304
Practice Address - Country:US
Practice Address - Phone:713-705-7953
Practice Address - Fax:832-478-9266
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00720OtherTEXAS MEDICAL BOARD
135207OtherNATIONAL BOARD OF SURGICAL TECHNOLOGIST AND SURGICAL ASSISTANTS