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General NPI Number Information
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NPI Number | 1689224578
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Entity Type | Individual
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Provider Name | JENNIFER SAMUEL PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 06/21/2025
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Provider Practice Location Address
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Address Line | 2004 HOSPITAL WAY
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City | WHITEFISH
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State | MT
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Zip | 59937-7858
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Country | US
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Telephone | 406-862-1030
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Fax | 406-862-1556
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Provider Business Mailing Address
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Address Line | 517 SHADY GLEN DR APT 202
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City | KALISPELL
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State | MT
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Zip | 59901-6229
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Country | US
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Telephone | 516-343-8802
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 309303
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10006786
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61425969
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 213628
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License Number State | MT
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