MEDICARE: MRS. SAMANTHA SOPHIA PECKHAM APRN FNP-BC PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	1667	NV
2	363L00000X	Nurse Practitioner	001667	NV

General Provider Information

NPI Number	:	1134546286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SAMANTHA SOPHIA PECKHAM APRN FNP-BC PMHNP-BC

Provider Business Mailing Address
First Line	:	4898 AL CARRISON ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3279
Country	:	US
Telephone Number	:	702-738-1775
Fax Number	:

Provider Business Practice Location Address
First Line	:	10040 W CHEYENNE AVE STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7721
Country	:	US
Telephone Number	:	702-907-5080
Fax Number	:	702-725-1416

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2014
Last Update Date	:	05/22/2025

Similar Medicare Providers

1437270584 — GERI LYNN GROSSAN
Practice Location Address:

7721 LEAVORITE DRIVE
LAS VEGAS, NV
89128

Practice Phone: 702-242-5730
Practice Fax: 702-242-1417

1750632899 — MRS. NEBBELA KARIM ZGHAIB
Practice Location Address:

3554 GREAT BEAR ST
LAS VEGAS, NV
89147-7721

Practice Phone: 702-217-1158
Practice Fax:

1518533496 — KAREN AILEEN RABAGO-AQUINO
Practice Location Address:

7721 WILD CREST ST
LAS VEGAS, NV
89149-1930

Practice Phone: 702-355-7547
Practice Fax:

1770224933 — MS. TIFFANY L HUDSON
Practice Location Address:

7721 CONSTANSO AVE UNIT 203
LAS VEGAS, NV
89128-8040

Practice Phone: 702-498-1570
Practice Fax:

1710762208 — BLANCA LOISELLE
Practice Location Address:

7721 LILY TROTTER ST
NORTH LAS VEGAS, NV
89084-2406

Practice Phone: 702-400-2788
Practice Fax:

1427804459 — MISS ANGELINA ABOU SHACKR ALJOT
Practice Location Address:

3554 GREAT BEAR ST
LAS VEGAS, NV
89147-7721

Practice Phone: 725-300-5059
Practice Fax:

Directions to “ MRS. SAMANTHA SOPHIA PECKHAM APRN FNP-BC PMHNP-BC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.