Healthcare Provider Details

I. General information

NPI: 1174445589
Provider Name (Legal Business Name): SAMANTHA DREW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 W KINGSHIGHWAY
PARAGOULD AR
72450-3430
US

IV. Provider business mailing address

5201 W KINGSHIGHWAY
PARAGOULD AR
72450-3430
US

V. Phone/Fax

Practice location:
  • Phone: 870-215-4450
  • Fax: 870-239-2148
Mailing address:
  • Phone: 870-215-4450
  • Fax: 870-239-2148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number215384
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: