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NPI Code Detail

MEDICARE: SAMANTHA DANIELLE KISAMORE

MEDICARE: SAMANTHA DANIELLE KISAMORE
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
1376K00000XNurse's Aide80681WV

General Provider Information

NPI Number : 1245848928
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA DANIELLE KISAMORE
Provider Business Mailing Address
First Line : 12 MAPLE HILL AVE STE 1
Second Line :
City : PETERSBURG
State : WV
Zip : 26847-1547
Country : US
Telephone Number : 304-257-9298
Fax Number :
Provider Business Practice Location Address
First Line : 12 MAPLE HILL AVE STE 1
Second Line :
City : PETERSBURG
State : WV
Zip : 26847-1547
Country : US
Telephone Number : 304-257-9298
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2020
Last Update Date : 07/17/2020

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Directions to “ SAMANTHA DANIELLE KISAMORE ” Practice Location

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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.

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