Healthcare Provider Details

I. General information

NPI: 1295693240
Provider Name (Legal Business Name): SAMANTHA LYNN BLUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 E MAIN ST
ADRIAN MO
64720-8201
US

IV. Provider business mailing address

7000B NW STATE ROUTE 18
ADRIAN MO
64720-4807
US

V. Phone/Fax

Practice location:
  • Phone: 816-372-2948
  • Fax:
Mailing address:
  • Phone: 816-267-8283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number20564
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: