Provider Demographics
NPI:1467920082
Name:ROBERTS, SAMANTHA GAIL (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:GAIL
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6947 HIGHWAY 541
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-7250
Mailing Address - Country:US
Mailing Address - Phone:606-666-5860
Mailing Address - Fax:
Practice Address - Street 1:219 MOUNTAIN PARKWAY SPUR RD
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-8988
Practice Address - Country:US
Practice Address - Phone:606-668-6932
Practice Address - Fax:606-668-3125
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily