Healthcare Provider Details

I. General information

NPI: 1457745358
Provider Name (Legal Business Name): SAMANTHA JO CHRISTOPHER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S 14TH ST
HERRIN IL
62948-3631
US

IV. Provider business mailing address

209 W COMMERCIAL DR STE E
CARTERVILLE IL
62918-2057
US

V. Phone/Fax

Practice location:
  • Phone: 618-942-2171
  • Fax: 618-351-4846
Mailing address:
  • Phone: 618-684-7087
  • Fax: 618-822-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277002107
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: