Provider Demographics
NPI:1851533939
Name:SAMPSON, KATHERINE ALLENE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ALLENE
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 N MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4610
Mailing Address - Country:US
Mailing Address - Phone:580-332-2323
Mailing Address - Fax:580-421-6042
Practice Address - Street 1:430 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4610
Practice Address - Country:US
Practice Address - Phone:580-332-2323
Practice Address - Fax:580-421-6042
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106-22772163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
00037002001OtherBLUE CROSS BLUE SHIELD
OK100728840AMedicaid
1619938040OtherSTATE OF OKLAHOMA
1619938040OtherTRICARE