Provider Demographics
NPI:1467184879
Name:EVERSOLE, SAMANTHA OCTAVIA (DO)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:OCTAVIA
Last Name:EVERSOLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 RALEIGH RD
Mailing Address - Street 2:
Mailing Address - City:CHAVIES
Mailing Address - State:KY
Mailing Address - Zip Code:41727-9049
Mailing Address - Country:US
Mailing Address - Phone:606-216-5640
Mailing Address - Fax:
Practice Address - Street 1:240 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858-7627
Practice Address - Country:US
Practice Address - Phone:606-633-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program