Healthcare Provider Details

I. General information

NPI: 1770262818
Provider Name (Legal Business Name): SAMANTHA MCCARTY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 MCCALL RD
MANHATTAN KS
66502-5001
US

IV. Provider business mailing address

435 MCCALL RD
MANHATTAN KS
66502-5001
US

V. Phone/Fax

Practice location:
  • Phone: 785-669-4152
  • Fax: 785-669-4153
Mailing address:
  • Phone: 785-669-4152
  • Fax: 785-669-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-03312
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: