Provider Demographics
NPI:1275134694
Name:WILKINS-COPELAND, SAMANTHA BONITA (FNP-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:BONITA
Last Name:WILKINS-COPELAND
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:BONITA
Other - Last Name:WILKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1522 PRISON RD
Mailing Address - Street 2:
Mailing Address - City:DILLWYN
Mailing Address - State:VA
Mailing Address - Zip Code:23936-3600
Mailing Address - Country:US
Mailing Address - Phone:434-983-4200
Mailing Address - Fax:
Practice Address - Street 1:1522 PRISON RD
Practice Address - Street 2:
Practice Address - City:DILLWYN
Practice Address - State:VA
Practice Address - Zip Code:23936-3600
Practice Address - Country:US
Practice Address - Phone:434-983-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28545363LF0000X
VA0024180321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily