Healthcare Provider Details

I. General information

NPI: 1255280111
Provider Name (Legal Business Name): SAMANTHA MARIE DAUGHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2026
Last Update Date: 01/24/2026
Certification Date: 01/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 GATEWAY BLVD
NEWBURGH IN
47630-8947
US

IV. Provider business mailing address

3403 JAYLYNN CT
EVANSVILLE IN
47725-7574
US

V. Phone/Fax

Practice location:
  • Phone: 812-842-3030
  • Fax:
Mailing address:
  • Phone: 812-842-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28229011A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: