Provider Demographics
NPI:1407502032
Name:DENTON, SAMANTHA P (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:P
Last Name:DENTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 OLYMPIC PLAZA CIR STE 700
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1954
Mailing Address - Country:US
Mailing Address - Phone:903-262-3900
Mailing Address - Fax:
Practice Address - Street 1:700 OLYMPIC PLAZA CIR STE 700
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1954
Practice Address - Country:US
Practice Address - Phone:903-262-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15470363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant