Provider Demographics
NPI:1891280343
Name:CLARKSON, SAMANTHA LYN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LYN
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LYN
Other - Last Name:HAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4403 HARRISON BLVD STE 3875
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3332
Mailing Address - Country:US
Mailing Address - Phone:801-387-7950
Mailing Address - Fax:
Practice Address - Street 1:4403 HARRISON BLVD STE 3875
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3332
Practice Address - Country:US
Practice Address - Phone:801-387-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8506342-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTPENDINGMedicaid