Healthcare Provider Details

I. General information

NPI: 1487367694
Provider Name (Legal Business Name): SAMANTHA LEE KARMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NORTH ONE MILE ROAD
DEXTER MO
63841
US

IV. Provider business mailing address

1200 N ONE MILE RD
DEXTER MO
63841-1000
US

V. Phone/Fax

Practice location:
  • Phone: 573-624-7575
  • Fax:
Mailing address:
  • Phone: 573-624-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022036966
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: