Provider Demographics
NPI:1467719807
Name:SAMUEL, JEANNIE RAY (PNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JEANNIE
Middle Name:RAY
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:PNP-BC
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 1559
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1559
Mailing Address - Country:US
Mailing Address - Phone:661-635-3050
Mailing Address - Fax:661-326-1347
Practice Address - Street 1:8787 HALL RD
Practice Address - Street 2:
Practice Address - City:LAMONT
Practice Address - State:CA
Practice Address - Zip Code:93241-1953
Practice Address - Country:US
Practice Address - Phone:661-845-3731
Practice Address - Fax:661-845-1157
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003356363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics