MEDICARE: SAMANTHA KENEFICK

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	163W00000X	Registered Nurse	1026357	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1026357	OTHER	TX	TEXAS BOARD OF NURSING

General Provider Information

NPI Number	:	1811571987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA KENEFICK

Provider Business Mailing Address
First Line	:	2114 BARRINGTON POINTE DR
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573
Country	:	US
Telephone Number	:	281-740-0944
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 BINZ ST STE 101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-6944
Country	:	US
Telephone Number	:	713-520-1210
Fax Number	:

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

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	05/05/2021

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Directions to “ SAMANTHA KENEFICK ” Practice Location

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