1982581245 NPI number — DR. SAMANTHA ASHLEY NICKELSON DC

Table of content: DR. SAMANTHA ASHLEY NICKELSON DC (NPI 1982581245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982581245 NPI number — DR. SAMANTHA ASHLEY NICKELSON DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICKELSON
Provider First Name:
SAMANTHA
Provider Middle Name:
ASHLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
ASHLEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982581245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1504 PACO TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76209-4644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-435-1164
Provider Business Mailing Address Fax Number:
940-213-1601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1504 PACO TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76209-4644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-435-1164
Provider Business Practice Location Address Fax Number:
940-213-1601
Provider Enumeration Date:
08/19/2025

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: 111N00000X , with the licence number:  16578 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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