Healthcare Provider Details

I. General information

NPI: 1598481723
Provider Name (Legal Business Name): SAMUEL P HAMILTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W RUSSELL ST
ELKHORN CITY KY
41522-9023
US

IV. Provider business mailing address

PO BOX 40
WHITESBURG KY
41858-0040
US

V. Phone/Fax

Practice location:
  • Phone: 606-754-8445
  • Fax: 606-754-8316
Mailing address:
  • Phone: 606-633-4823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3018544
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: