Provider Demographics
NPI:1679252019
Name:BENNETT, SAMANTHA NECOLE
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NECOLE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:NECOLE
Other - Last Name:MCREYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3497 WAGON WHEEL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0115
Mailing Address - Country:US
Mailing Address - Phone:479-717-2467
Mailing Address - Fax:479-445-6091
Practice Address - Street 1:3497 WAGON WHEEL RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0115
Practice Address - Country:US
Practice Address - Phone:479-717-2467
Practice Address - Fax:479-445-6091
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic