Provider Demographics
NPI:1326302290
Name:SAMPSON, SONDRA ANN
Entity Type:Individual
Prefix:MRS
First Name:SONDRA
Middle Name:ANN
Last Name:SAMPSON
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 1:114 JOHN DR
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-2005
Mailing Address - Country:US
Mailing Address - Phone:918-839-2960
Mailing Address - Fax:918-567-2417
Practice Address - Street 1:114 JOHN DR
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2005
Practice Address - Country:US
Practice Address - Phone:918-839-2960
Practice Address - Fax:918-567-2417
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health