Provider Demographics
NPI:1295154805
Name:RUSHTON, SAMANTHA JOELLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:JOELLE
Last Name:RUSHTON
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-0647
Mailing Address - Country:US
Mailing Address - Phone:910-483-7337
Mailing Address - Fax:910-483-0648
Practice Address - Street 1:100 S 10TH ST STE B
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-6690
Practice Address - Country:US
Practice Address - Phone:910-984-8229
Practice Address - Fax:910-514-9717
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2016-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC001004756363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1295154805OtherDOCTORS DIRECT
NC1295154805Medicaid
NC1461976OtherWELLPATH
NC186WSOtherBCBS OF NC
NCFH4001720OtherFIRST CAROLINA CARE
NC4302372OtherCOVENTRY NATIONAL PPO
NC251128OtherMEDCOST, LLC
NC4341301OtherUNITED HEALTHCARE
NC4741883OtherAETNA
NC5678738OtherCIGNA/GREATWEST
NC13356163OtherPHCS/MULTIPLAN
NC1461976OtherCOVENTRY OF NC
NC1295154805OtherHEALTHNET FEDERAL SERVICES
NC1295154805OtherHUMANA
NC1295154805OtherHEALTHSMART