Provider Demographics
NPI:1477242071
Name:CRAVENS, SAMANTHA KAYE (CBC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KAYE
Last Name:CRAVENS
Suffix:
Gender:F
Credentials:CBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 NANNIE BELLE LOOP
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-9586
Mailing Address - Country:US
Mailing Address - Phone:270-314-6599
Mailing Address - Fax:
Practice Address - Street 1:2200 E PARRISH AVE STE 202
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-478-1014
Practice Address - Fax:270-201-7286
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6265174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN