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NPI Code Detail

MEDICARE: SAMANTHA NICHOLE HUNTSMAN PA-C

MEDICARE: SAMANTHA NICHOLE HUNTSMAN PA-C
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
1363A00000XPhysician AssistantTN

General Provider Information

NPI Number : 1538811153
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA NICHOLE HUNTSMAN PA-C
Provider Business Mailing Address
First Line : 4250 GOURLEY RD
Second Line :
City : PEGRAM
State : TN
Zip : 37143-5004
Country : US
Telephone Number : 731-514-6411
Fax Number :
Provider Business Practice Location Address
First Line : 2004 HAYES ST STE 200
Second Line :
City : NASHVILLE
State : TN
Zip : 37203-2689
Country : US
Telephone Number : 615-324-1600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2022
Last Update Date : 01/25/2022

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Directions to “ SAMANTHA NICHOLE HUNTSMAN PA-C” Practice Location

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