Provider Demographics
NPI:1942703863
Name:CASTLEBURY, SAMANTHA JO (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:JO
Last Name:CASTLEBURY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 SE SALEM STREET
Mailing Address - Street 2:OAK GROVE MEDICAL CLINIC
Mailing Address - City:OAK GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:64075-9299
Mailing Address - Country:US
Mailing Address - Phone:816-690-6566
Mailing Address - Fax:
Practice Address - Street 1:302 SE SALEM
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MO
Practice Address - Zip Code:64075
Practice Address - Country:US
Practice Address - Phone:816-690-6566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018003288363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner