Healthcare Provider Details

I. General information

NPI: 1659962397
Provider Name (Legal Business Name): KENDRA FRAZIER SAMUELSON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WALDEN RIDGE DR STE 25
ASHEVILLE NC
28803-8598
US

IV. Provider business mailing address

60 WALNUT SPRINGS DR
ASHEVILLE NC
28804-7701
US

V. Phone/Fax

Practice location:
  • Phone: 828-503-0008
  • Fax:
Mailing address:
  • Phone: 828-460-8815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5014013
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: