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NPI Code Detail

MEDICARE: SAMANTHA BLAYLOCK

MEDICARE: SAMANTHA BLAYLOCK
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
1164W00000XLicensed Practical Nurse36494WV

General Provider Information

NPI Number : 1932033651
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA BLAYLOCK
Provider Business Mailing Address
First Line : PO BOX 618
Second Line :
City : NORTHFORK
State : WV
Zip : 24868-0618
Country : US
Telephone Number : 304-425-9541
Fax Number :
Provider Business Practice Location Address
First Line : 200 12TH STREET EXT
Second Line :
City : PRINCETON
State : WV
Zip : 24740-2329
Country : US
Telephone Number : 304-425-9541
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2026
Last Update Date : 06/09/2026

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Directions to “ SAMANTHA BLAYLOCK ” Practice Location

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