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General NPI Number Information
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NPI Number | 1801788104
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Entity Type | Individual
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Provider Name | SAMANTHA JANIECE DOUGLAS APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/19/2025
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Last Update Date | 07/19/2025
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Provider Practice Location Address
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Address Line | 601 E CARL ALBERT PKWY
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City | MCALESTER
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State | OK
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Zip | 74501-5113
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Country | US
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Telephone | 918-233-6522
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Fax |
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Provider Business Mailing Address
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Address Line | 2359 KREBS LAKE RD
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City | MCALESTER
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State | OK
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Zip | 74501-2773
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Country | US
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Telephone | 918-916-7142
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 224848
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License Number State | OK
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