Provider Demographics
NPI:1699412247
Name:SAMPLES, AMBER JORDAN (CRNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:JORDAN
Last Name:SAMPLES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:JORDAN
Other - Last Name:UPTAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:253 LANE DR
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35962-3360
Mailing Address - Country:US
Mailing Address - Phone:256-659-8566
Mailing Address - Fax:
Practice Address - Street 1:503 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5103
Practice Address - Country:US
Practice Address - Phone:256-546-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF01220239363LF0000X
AL1-157491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily