Provider Demographics
NPI:1154824498
Name:AMOS, SAMANTHA E (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:E
Last Name:AMOS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:E
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-0249
Mailing Address - Country:US
Mailing Address - Phone:336-679-4963
Mailing Address - Fax:336-679-2549
Practice Address - Street 1:210 QUAIL RUN RD
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:VA
Practice Address - Zip Code:24375-3286
Practice Address - Country:US
Practice Address - Phone:276-686-5334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175952363LP2300X
NC5010487363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care