MEDICARE: MS. CINDY K SAMPSON 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
1	363A00000X	Physician Assistant	PA1737	KY

General Provider Information

NPI Number	:	1902987704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CINDY K SAMPSON PA-C

Provider Business Mailing Address
First Line	:	4331 CHURCHMAN AVE
Second Line	:	STE 101
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-1164
Country	:	US
Telephone Number	:	502-364-0902
Fax Number	:	502-364-0099

Provider Business Practice Location Address
First Line	:	4331 CHURCHMAN AVE
Second Line	:	STE 101
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-1164
Country	:	US
Telephone Number	:	502-364-0902
Fax Number	:	502-364-0099

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/20/2015

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