Healthcare Provider Details

I. General information

NPI: 1699372383
Provider Name (Legal Business Name): SAMANTHA KIBLER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7337 CARITAS CIR NW STE 150
MASSILLON OH
44646-9128
US

IV. Provider business mailing address

7337 CARITAS CIR NW STE 150
MASSILLON OH
44646-9128
US

V. Phone/Fax

Practice location:
  • Phone: 330-478-0001
  • Fax: 330-837-2646
Mailing address:
  • Phone: 330-478-0001
  • Fax: 330-837-2646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: