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General NPI Number Information
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NPI Number | 1902583917
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Entity Type | Individual
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Provider Name | ASHLEY SAMANIEGO PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/30/2023
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 2204 PAVILION DR STE 107
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City | KINGSPORT
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State | TN
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Zip | 37660-4651
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Country | US
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Telephone | 423-392-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 W OAKLAND AVE STE 310
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2192
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Country | US
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Telephone | 423-952-2111
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Fax | 423-282-1657
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 180297
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License Number State | TN
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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 | 36562
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License Number State | TN
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