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NPI Code Detail

MEDICARE: SAMANTHA DANIELLE STATHAM NP

MEDICARE: SAMANTHA DANIELLE STATHAM NP
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
1363L00000XNurse Practitioner37098TN
2363L00000XNurse Practitioner906894MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
137098OTHERTNSTATE LICENSE
2906894OTHERMSLICENSURE

General Provider Information

NPI Number : 1568291672
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA DANIELLE STATHAM NP
Provider Business Mailing Address
First Line : 129 CENTER ST STE B
Second Line :
City : RICHLAND
State : MS
Zip : 39218-4800
Country : US
Telephone Number : 769-233-7141
Fax Number : 769-233-7726
Provider Business Practice Location Address
First Line : 129 CENTER ST STE B
Second Line :
City : RICHLAND
State : MS
Zip : 39218-4800
Country : US
Telephone Number : 769-233-7141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2024
Last Update Date : 09/09/2025

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Directions to “ SAMANTHA DANIELLE STATHAM NP” Practice Location

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