Healthcare Provider Details

I. General information

NPI: 1639725823
Provider Name (Legal Business Name): SAMANTHA EUGENIA FREEMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E REPUBLIC RD
SPRINGFIELD MO
65804-7209
US

IV. Provider business mailing address

1377 MONTAGUE RD
HIGHLANDVILLE MO
65669-8180
US

V. Phone/Fax

Practice location:
  • Phone: 417-823-4893
  • Fax:
Mailing address:
  • Phone: 417-559-3759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019031432
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: