Healthcare Provider Details

I. General information

NPI: 1033082367
Provider Name (Legal Business Name): SAMANTHA NICOLE CARRIER AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 FAIRMONT BLVD
RAPID CITY SD
57701-7375
US

IV. Provider business mailing address

1555 PANTS BUTTE RD
HARRISON NE
69346-2180
US

V. Phone/Fax

Practice location:
  • Phone: 419-378-1891
  • Fax:
Mailing address:
  • Phone: 419-378-1891
  • Fax: 419-378-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number200711
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number116325
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: