Provider Demographics
NPI:1821656174
Name:MCDOUGAL, SAMANTHA AUDREY (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:AUDREY
Last Name:MCDOUGAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1200 MOUNTAIN ST STE 230
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-3867
Mailing Address - Country:US
Mailing Address - Phone:775-283-5029
Mailing Address - Fax:
Practice Address - Street 1:1475 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4635
Practice Address - Country:US
Practice Address - Phone:775-883-3636
Practice Address - Fax:775-882-2382
Is Sole Proprietor?:No
Enumeration Date:2019-06-02
Last Update Date:2023-03-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant