1720398324 NPI number — MRS. SAMANTHA COLEEN HUSKEY NP

Table of content: MRS. SAMANTHA COLEEN HUSKEY NP (NPI 1720398324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720398324 NPI number — MRS. SAMANTHA COLEEN HUSKEY NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUSKEY
Provider First Name:
SAMANTHA
Provider Middle Name:
COLEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOODY
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
COLEEN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720398324
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 589
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37322-0589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-334-4154
Provider Business Mailing Address Fax Number:
423-334-4149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37322-7801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-334-4154
Provider Business Practice Location Address Fax Number:
423-334-4149
Provider Enumeration Date:
10/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  15168 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com