Provider Demographics
NPI:1528575545
Name:MYERS, SAMANTHA JOELLEN (APRN)
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:JOELLEN
Last Name:MYERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:1717 S UTICA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5346
Mailing Address - Country:US
Mailing Address - Phone:918-748-7557
Mailing Address - Fax:918-403-0383
Practice Address - Street 1:1717 S UTICA AVE
Practice Address - Street 2:STE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-748-7557
Practice Address - Fax:918-403-0383
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2018-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS77484207Q00000X
OK98444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine