Provider Demographics
NPI:1043595960
Name:CARLSON, SAMANTHA R (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:R
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 WATERSCAPE WAY
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7097
Mailing Address - Country:US
Mailing Address - Phone:252-531-5301
Mailing Address - Fax:252-531-5305
Practice Address - Street 1:2020 WATERSCAPE WAY
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-7097
Practice Address - Country:US
Practice Address - Phone:252-531-5301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04129363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical