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General NPI Number Information
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NPI Number | 1962917922
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Entity Type | Individual
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Provider Name | SAMANTHA TAYLOR PRIMM PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 1200 S FARMERVILLE ST
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City | RUSTON
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State | LA
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Zip | 71270-5941
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Country | US
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Telephone | 318-255-3690
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Fax | 318-251-6116
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Provider Business Mailing Address
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Address Line | 2037 W MAIN ST
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City | CABOT
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State | AR
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Zip | 72023-7479
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Country | US
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Telephone |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-754
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 329438
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License Number State | LA
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