Healthcare Provider Details

I. General information

NPI: 1639299886
Provider Name (Legal Business Name): SAMANTHA S MCINTOSH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 FOREST SERVICE DR STE A MITCHELL COUNTY HEALTH DEPT
BAKERSVILLE NC
28705-7047
US

IV. Provider business mailing address

202 MEDICAL CAMPUS DR
BURNSVILLE NC
28714-9004
US

V. Phone/Fax

Practice location:
  • Phone: 828-688-2371
  • Fax: 828-688-3866
Mailing address:
  • Phone: 828-682-6118
  • Fax: 828-682-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201775
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: