Provider Demographics
NPI:1639299886
Name:MCINTOSH, SAMANTHA S (FNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:S
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 MEDICAL CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-9004
Mailing Address - Country:US
Mailing Address - Phone:828-682-6118
Mailing Address - Fax:828-682-6262
Practice Address - Street 1:130 FOREST SERVICE DR STE A
Practice Address - Street 2:MITCHELL COUNTY HEALTH DEPT
Practice Address - City:BAKERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28705-7047
Practice Address - Country:US
Practice Address - Phone:828-688-2371
Practice Address - Fax:828-688-3866
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC201775OtherSTATE LICENSE