Healthcare Provider Details

I. General information

NPI: 1962007401
Provider Name (Legal Business Name): SAMANTHA YEAREGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 MAIN ST E
OAK HILL WV
25901-2341
US

IV. Provider business mailing address

303 SADDLESHOP RD
OAK HILL WV
25901-5889
US

V. Phone/Fax

Practice location:
  • Phone: 304-465-0885
  • Fax: 304-465-0886
Mailing address:
  • Phone: 304-640-4899
  • Fax: 304-471-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: