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General NPI Number Information
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NPI Number | 1619459641
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Entity Type | Individual
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Provider Name | STACEY M SAMS CNP
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Gender | Female
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 751 STATE ROUTE 664 N UNIT A
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City | LOGAN
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State | OH
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Zip | 43138-9250
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Country | US
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Telephone | 740-385-9646
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Fax | 740-385-0630
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Provider Business Mailing Address
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Address Line | 416 COLEGATE DR BLDG 3
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City | MARIETTA
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State | OH
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Zip | 45750-9549
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Country | US
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Telephone | 740-374-3526
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Fax | 740-374-3165
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.023605
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License Number State | OH
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