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General NPI Number Information
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NPI Number | 1184261166
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Entity Type | Individual
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Provider Name | SAMANTHA RAE TOLLEY-MUSALL FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/09/2019
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 2751 ALBRIGHT RD
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City | KOKOMO
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State | IN
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Zip | 46902-3996
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Country | US
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Telephone | 765-450-4843
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Fax | 765-450-4895
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Provider Business Mailing Address
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Address Line | 4031 S WEBSTER ST
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City | KOKOMO
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State | IN
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Zip | 46902-6911
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Country | US
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Telephone | 765-626-6667
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Fax | 765-626-6057
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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 | 28156612A
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License Number State | IN
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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 | 71009649A
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License Number State | IN
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