Healthcare Provider Details

I. General information

NPI: 1548673403
Provider Name (Legal Business Name): SAMANTHA BAGGETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 MAIN ST
ROANOKE AL
36274-2512
US

IV. Provider business mailing address

1950 MAIN ST
ROANOKE AL
36274-2512
US

V. Phone/Fax

Practice location:
  • Phone: 334-863-2311
  • Fax: 334-863-5596
Mailing address:
  • Phone: 334-863-2311
  • Fax: 334-863-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1131453
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: