Provider Demographics
NPI:1801819503
Name:STONE, SAMANTHA STACY (C-FNP)
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:STACY
Last Name:STONE
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CAPITOL ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1220
Mailing Address - Country:US
Mailing Address - Phone:304-720-8822
Mailing Address - Fax:
Practice Address - Street 1:505 CAPITOL ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1220
Practice Address - Country:US
Practice Address - Phone:304-720-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV54190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7104086000Medicaid
WVNP08677Medicare ID - Type Unspecified
WV7104086000Medicaid