Healthcare Provider Details

I. General information

NPI: 1063044386
Provider Name (Legal Business Name): SAMANTHA TAYLOR HART APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W 15TH ST
OTTAWA KS
66067-3953
US

IV. Provider business mailing address

1637 SW ARBORWAY TER
LEES SUMMIT MO
64082-5600
US

V. Phone/Fax

Practice location:
  • Phone: 785-242-5399
  • Fax:
Mailing address:
  • Phone: 918-346-2705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-82095-012
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2023011052
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: