Healthcare Provider Details

I. General information

NPI: 1063398725
Provider Name (Legal Business Name): SAMANTHA MAGEE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 HWY 24 SUITE A
CENTREVILLE MS
39645-6278
US

IV. Provider business mailing address

178 HWY 24 SUITE A
CENTREVILLE MS
39631
US

V. Phone/Fax

Practice location:
  • Phone: 601-890-0520
  • Fax:
Mailing address:
  • Phone: 601-890-0520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number242818
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number907474
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: