Healthcare Provider Details

I. General information

NPI: 1265301212
Provider Name (Legal Business Name): SAMANTHA MCDONALD MS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 N RIVERPOINT BLVD APT H102
SPOKANE WA
99202-1673
US

IV. Provider business mailing address

3724 JEFFERSON ST STE 104
AUSTIN TX
78731-6204
US

V. Phone/Fax

Practice location:
  • Phone: 801-635-6498
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: