Healthcare Provider Details

I. General information

NPI: 1851805196
Provider Name (Legal Business Name): SAMANTHA RUTH CHARTIER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA RUTH DAVIS PA-C

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CHENEY DR W STE 200
TWIN FALLS ID
83301-4278
US

IV. Provider business mailing address

1502 LOCUST ST N STE 700
TWIN FALLS ID
83301-4164
US

V. Phone/Fax

Practice location:
  • Phone: 208-736-7422
  • Fax:
Mailing address:
  • Phone: 208-595-5095
  • Fax: 208-595-5258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: