MEDICARE: SAMANTHA M CLIFFORD MSN, APRN, 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	3011469	KY

General Provider Information

NPI Number	:	1881116929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA M CLIFFORD MSN, APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	3198 SQUIRE CIR
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8589
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2327 LIME KILN LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-3422
Country	:	US
Telephone Number	:	502-414-4557
Fax Number	:

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

Provider Enumeration Date	:	07/11/2017
Last Update Date	:	03/13/2020

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