Healthcare Provider Details

I. General information

NPI: 1417675208
Provider Name (Legal Business Name): EMMA SAMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 SAINT JAMES DR
EDMOND OK
73034-6683
US

IV. Provider business mailing address

5316 NW 109TH ST
OKLAHOMA CITY OK
73162-5900
US

V. Phone/Fax

Practice location:
  • Phone: 405-432-9198
  • Fax:
Mailing address:
  • Phone: 405-432-9198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number48074
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: