Healthcare Provider Details

I. General information

NPI: 1144902636
Provider Name (Legal Business Name): SAMANTHA ROSE KRAMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 CUMBERLAND RD
CEDAR BLUFF VA
24609-1137
US

IV. Provider business mailing address

PO BOX 810
CEDAR BLUFF VA
24609-0810
US

V. Phone/Fax

Practice location:
  • Phone: 276-964-6702
  • Fax:
Mailing address:
  • Phone: 276-889-3063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: