Provider Demographics
NPI:1720398324
Name:HUSKEY, SAMANTHA COLEEN (NP)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:COLEEN
Last Name:HUSKEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:COLEEN
Other - Last Name:WOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TN
Mailing Address - Zip Code:37322-0589
Mailing Address - Country:US
Mailing Address - Phone:423-334-4154
Mailing Address - Fax:423-334-4149
Practice Address - Street 1:305 RIVER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TN
Practice Address - Zip Code:37322-7801
Practice Address - Country:US
Practice Address - Phone:423-334-4154
Practice Address - Fax:423-334-4149
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily