Provider Demographics
NPI:1750381950
Name:CARPENTER, SAMANTHA S (WHCNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:S
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5200 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7709
Practice Address - Country:US
Practice Address - Phone:214-590-5306
Practice Address - Fax:214-590-2798
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1019567367A00000X
TX596949363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144875512Medicaid
TX8N4868OtherBLUE CROSS BLUE SHIELD
TX144875507Medicaid
TX144875511Medicaid
TX144875510Medicaid
TX144875509Medicaid
TX144875502Medicaid
TX144875505Medicaid
TX144875506Medicaid
TX144875501Medicaid
TX144875504Medicaid
TX144875503Medicaid
TX144875508Medicaid
TX144875502Medicaid
TX144875511Medicaid