Provider Demographics
NPI:1083353825
Name:HARPER, SAMANTHA C
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:C
Last Name:HARPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 29TH AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2843
Mailing Address - Country:US
Mailing Address - Phone:228-263-4420
Mailing Address - Fax:
Practice Address - Street 1:801 35TH ST APT B
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-7107
Practice Address - Country:US
Practice Address - Phone:601-454-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X, 374U00000X, 376J00000X, 376K00000X
MS800034164343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide