Provider Demographics
NPI:1508495128
Name:SAMPSON, KATE MARIE (AGPC-NP)
Entity Type:Individual
Prefix:MS
First Name:KATE
Middle Name:MARIE
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:AGPC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 DOOLITTLE RD
Mailing Address - Street 2:
Mailing Address - City:LOCKWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14859-9604
Mailing Address - Country:US
Mailing Address - Phone:607-483-5491
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY563216163WM0705X
PARN573333163WM0705X
NYF310097-01363LA2200X
PASP023243363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health