MEDICARE: MRS. SAMANTHA E AMOS NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	0024175952	VA
2	363LA2200X	Adult Health Nurse Practitioner	5010487	NC

General Provider Information

NPI Number	:	1154824498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SAMANTHA E AMOS NP-C

Provider Business Mailing Address
First Line	:	PO BOX 249
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-0249
Country	:	US
Telephone Number	:	336-679-4963
Fax Number	:	336-679-2549

Provider Business Practice Location Address
First Line	:	210 QUAIL RUN RD
Second Line	:
City	:	SUGAR GROVE
State	:	VA
Zip	:	24375-3286
Country	:	US
Telephone Number	:	276-686-5334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2018
Last Update Date	:	05/09/2018

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