=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427985118
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMANTHA PAIGE ROSE LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2026
-----------------------------------------------------
Last Update Date | 05/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 VIRGINIA ST E STE 400
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25301-2835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 681-313-4759
-----------------------------------------------------
Fax | 844-800-3954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 ROSE LN
-----------------------------------------------------
City | KERMIT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25674-7328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-601-5775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 38624
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------