Healthcare Provider Details

I. General information

NPI: 1881576866
Provider Name (Legal Business Name): SAMANTHA MUNCY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/15/2025
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number123784
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: