Provider Demographics
NPI:1821694639
Name:KIZZIRE, SAMANTHA KAY (APRN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KAY
Last Name:KIZZIRE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:KAY
Other - Last Name:MOLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1720 N ST
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-2630
Mailing Address - Country:US
Mailing Address - Phone:402-450-1377
Mailing Address - Fax:
Practice Address - Street 1:402 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:OSMOND
Practice Address - State:NE
Practice Address - Zip Code:68765-5726
Practice Address - Country:US
Practice Address - Phone:402-748-3393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily