Provider Demographics
NPI:1821189879
Name:HERNANDEZ, SAMNIENG M (APN)
Entity Type:Individual
Prefix:
First Name:SAMNIENG
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-0700
Mailing Address - Country:US
Mailing Address - Phone:479-229-8000
Mailing Address - Fax:479-477-3927
Practice Address - Street 1:1652 STATE HIGHWAY 22 W
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-2909
Practice Address - Country:US
Practice Address - Phone:479-229-8000
Practice Address - Fax:479-477-3927
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR68707163WP0808X
ARA003015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166912758Medicaid