Provider Demographics
NPI:1003186081
Name:SAMS, BRANDON KENYON
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:KENYON
Last Name:SAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 FULLER ST
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-4307
Mailing Address - Country:US
Mailing Address - Phone:620-402-6386
Mailing Address - Fax:
Practice Address - Street 1:1317 WHEAT RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-4703
Practice Address - Country:US
Practice Address - Phone:620-221-7021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant