Healthcare Provider Details

I. General information

NPI: 1194469338
Provider Name (Legal Business Name): SAMANTHA LYNN WESTBROOK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA LYNN GARRETSON

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PENNSYLVANIA AVE
CHARLESTON WV
25302-3351
US

IV. Provider business mailing address

800 PENNSYLVANIA AVE
CHARLESTON WV
25302-3351
US

V. Phone/Fax

Practice location:
  • Phone: 304-414-1880
  • Fax: 104-414-1886
Mailing address:
  • Phone: 304-414-1880
  • Fax: 104-414-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4699
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: