Provider Demographics
NPI:1831961333
Name:THOMAS, SAMANTHA LYNN
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:LYNN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 N HARRISON ST TRLR 121
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3125
Mailing Address - Country:US
Mailing Address - Phone:405-788-9250
Mailing Address - Fax:
Practice Address - Street 1:26 FATHER JOE MURPHY DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-8663
Practice Address - Country:US
Practice Address - Phone:405-214-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator