Provider Demographics
NPI:1538807318
Name:HUSSMAN, AMBER (NP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:HUSSMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 DOCTORS HOSPITAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-2276
Mailing Address - Country:US
Mailing Address - Phone:940-255-2526
Mailing Address - Fax:
Practice Address - Street 1:1903 DOCTORS HOSPITAL DR STE 1
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2276
Practice Address - Country:US
Practice Address - Phone:940-255-2526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX1086317363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program