Provider Demographics
NPI:1417733270
Name:ROMERO, SAMANTHA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ROMERO
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:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:JESSIEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71949-0205
Mailing Address - Country:US
Mailing Address - Phone:501-538-8925
Mailing Address - Fax:
Practice Address - Street 1:7919 N HIGHWAY 7 # 205
Practice Address - Street 2:
Practice Address - City:JESSIEVILLE
Practice Address - State:AR
Practice Address - Zip Code:71949-8426
Practice Address - Country:US
Practice Address - Phone:501-538-8925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR226030363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care