Provider Demographics
NPI:1134546286
Name:PECKHAM, SAMANTHA SOPHIA (APRN FNP-BC PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:SOPHIA
Last Name:PECKHAM
Suffix:
Gender:F
Credentials:APRN FNP-BC PMHNP-BC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:SOPHIA
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4898 AL CARRISON ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-3279
Mailing Address - Country:US
Mailing Address - Phone:702-738-1775
Mailing Address - Fax:
Practice Address - Street 1:10040 W CHEYENNE AVE STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7721
Practice Address - Country:US
Practice Address - Phone:702-907-5080
Practice Address - Fax:702-725-1416
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1667363L00000X
NV001667363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner