Provider Demographics
NPI:1457609091
Name:NEVILLE, SAMANTHA LYNN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LYNN
Last Name:NEVILLE
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 1:3238 S NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7303
Mailing Address - Country:US
Mailing Address - Phone:417-351-2900
Mailing Address - Fax:417-351-2900
Practice Address - Street 1:3238 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7303
Practice Address - Country:US
Practice Address - Phone:417-351-2900
Practice Address - Fax:417-351-2900
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006028433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO431560263OtherTRICARE
MO1457609091Medicaid
MOP01159458OtherRR MCR
MO132300263Medicare PIN
MO132680389Medicare PIN