Healthcare Provider Details

I. General information

NPI: 1558725689
Provider Name (Legal Business Name): SAMANTHA J PUGH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8902 N MERIDIAN ST STE 100
INDIANAPOLIS IN
46260-5306
US

IV. Provider business mailing address

8902 N MERIDIAN ST STE 100
INDIANAPOLIS IN
46260-5306
US

V. Phone/Fax

Practice location:
  • Phone: 317-643-4444
  • Fax:
Mailing address:
  • Phone: 317-643-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006174A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: