Healthcare Provider Details

I. General information

NPI: 1043135999
Provider Name (Legal Business Name): SAMANTHA RIDDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 WASHINGTON AVE
WHEELING WV
26003-6243
US

IV. Provider business mailing address

1252 26TH ST
HUNTINGTON WV
25705-1112
US

V. Phone/Fax

Practice location:
  • Phone: 304-840-5921
  • Fax:
Mailing address:
  • Phone: 304-840-5921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: