Provider Demographics
NPI:1871676494
Name:SAMPSON, DAWN M (PA)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:BLAKEMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4222 LONG BEACH RD SE
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-8627
Mailing Address - Country:US
Mailing Address - Phone:910-454-4732
Mailing Address - Fax:
Practice Address - Street 1:9101 OCEAN HWY E
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451
Practice Address - Country:US
Practice Address - Phone:910-341-3300
Practice Address - Fax:910-251-2067
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001002455363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCN16520006Medicare PIN
MIS73732Medicare UPIN
NCS73732Medicare UPIN
MIN16520006Medicare PIN