Healthcare Provider Details

I. General information

NPI: 1972003184
Provider Name (Legal Business Name): SAMANTHA MARIE SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 STATE ST
AUGUSTA KS
67010-1126
US

IV. Provider business mailing address

1306 STATE ST
AUGUSTA KS
67010-1126
US

V. Phone/Fax

Practice location:
  • Phone: 316-775-9191
  • Fax: 316-775-0348
Mailing address:
  • Phone: 316-775-9191
  • Fax: 316-775-0348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-78001-032
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: