Provider Demographics
NPI:1659979169
Name:MORRIS, SAMANTHA ROSE
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ROSE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:KASTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SAMANTHA KASTMAN
Mailing Address - Street 1:1980 SE BLUE PKWY STE 2330
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1101
Mailing Address - Country:US
Mailing Address - Phone:816-607-2917
Mailing Address - Fax:818-607-2990
Practice Address - Street 1:1980 SE BLUE PKWY STE 2320
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-1102
Practice Address - Country:US
Practice Address - Phone:816-607-2917
Practice Address - Fax:816-607-2990
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020034777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily