Healthcare Provider Details

I. General information

NPI: 1013854645
Provider Name (Legal Business Name): SAMONYCA SPILLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 INVERNESS PL
FORT THOMAS KY
41075-1380
US

IV. Provider business mailing address

802 INVERNESS PL
FORT THOMAS KY
41075-1380
US

V. Phone/Fax

Practice location:
  • Phone: 304-416-0325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCHW.002448
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number260339
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: