Provider Demographics
NPI:1013310143
Name:CARTER, SAMANTHA POOLE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:POOLE
Last Name:CARTER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6599
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-6599
Mailing Address - Country:US
Mailing Address - Phone:334-944-7056
Mailing Address - Fax:334-944-7063
Practice Address - Street 1:4300 W MAIN ST STE 15
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1058
Practice Address - Country:US
Practice Address - Phone:334-944-7056
Practice Address - Fax:334-944-7063
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-098886363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner