Healthcare Provider Details

I. General information

NPI: 1215596192
Provider Name (Legal Business Name): STEPHANIE MICHELLE SAMPSON DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 S MAIN ST STE 150
LOGAN UT
84321-6568
US

IV. Provider business mailing address

PO BOX 245
LOGAN UT
84323-0245
US

V. Phone/Fax

Practice location:
  • Phone: 435-990-4282
  • Fax: 435-355-3718
Mailing address:
  • Phone: 435-990-4282
  • Fax: 435-355-3718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7734927-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: