Healthcare Provider Details

I. General information

NPI: 1609679141
Provider Name (Legal Business Name): SAMANTHA DAWN GILMAN MSN, APRN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 MACCORKLE AVE SE
CHARLESTON WV
25304-1334
US

IV. Provider business mailing address

4666 STATE HIGHWAY 1056
RANSOM KY
41558-8423
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-8380
  • Fax:
Mailing address:
  • Phone: 859-270-2476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4034515
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number122639
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: