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General NPI Number Information
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NPI Number | 1154133676
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Entity Type | Individual
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Provider Name | SAMANTHA RENEE FRALEY
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Gender | Female
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 11/30/2025
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Provider Practice Location Address
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Address Line | 18765 RIVERSIDE DR
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City | VANSANT
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State | VA
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Zip | 24656
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Country | US
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Telephone | 276-935-2880
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 144
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City | BIG ROCK
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State | VA
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Zip | 24603-0144
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Country | US
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Telephone | 423-754-7768
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001246096
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024192519
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License Number State | VA
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