Provider Demographics
NPI:1043181555
Name:SAMPSON, PAYTON EMMAKAY
Entity type:Individual
Prefix:MRS
First Name:PAYTON
Middle Name:EMMAKAY
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAYTON
Other - Middle Name:EMMAKAY
Other - Last Name:BEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57191 843 RD
Mailing Address - Street 2:
Mailing Address - City:PILGER
Mailing Address - State:NE
Mailing Address - Zip Code:68768-4064
Mailing Address - Country:US
Mailing Address - Phone:402-833-8876
Mailing Address - Fax:
Practice Address - Street 1:3206 RAASCH DR STE 300
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3175
Practice Address - Country:US
Practice Address - Phone:402-379-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities