Provider Demographics
NPI:1962038570
Name:WARREN, SAMANTHA MONTGOMERY (FNP-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MONTGOMERY
Last Name:WARREN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23447 SHELL RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-5373
Mailing Address - Country:US
Mailing Address - Phone:276-608-5800
Mailing Address - Fax:
Practice Address - Street 1:3900 WESTERRE PARKWAY
Practice Address - Street 2:SUITE 300 PMB# 308
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233
Practice Address - Country:US
Practice Address - Phone:276-608-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-15
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178134363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner