Provider Demographics
NPI:1700286002
Name:MILLER, SAMANTHA J (FNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:J
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:SOPHIA
Mailing Address - State:WV
Mailing Address - Zip Code:25921-0759
Mailing Address - Country:US
Mailing Address - Phone:304-683-2022
Mailing Address - Fax:304-683-2024
Practice Address - Street 1:833 ROBERT C BYRD DRIVE
Practice Address - Street 2:
Practice Address - City:SOPHIA
Practice Address - State:WV
Practice Address - Zip Code:25921
Practice Address - Country:US
Practice Address - Phone:304-683-2022
Practice Address - Fax:304-683-2024
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN78557-FNP-BC363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV4618AMedicare PIN