Provider Demographics
NPI:1275088635
Name:KUPLICKI, SAMANTHA (APRN-CNS, ACGCNS-BC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:KUPLICKI
Suffix:
Gender:F
Credentials:APRN-CNS, ACGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 E 108TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-6707
Mailing Address - Country:US
Mailing Address - Phone:918-812-1200
Mailing Address - Fax:
Practice Address - Street 1:1809 E 13TH ST
Practice Address - Street 2:STE 400
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4419
Practice Address - Country:US
Practice Address - Phone:918-599-8200
Practice Address - Fax:918-579-2559
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0101047163WW0000X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care