Provider Demographics
NPI:1063044386
Name:HART, SAMANTHA TAYLOR (APRN)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:TAYLOR
Last Name:HART
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 SW ARBORWAY TER
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-5600
Mailing Address - Country:US
Mailing Address - Phone:847-386-7744
Mailing Address - Fax:
Practice Address - Street 1:3330 SKOKIE VALLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-1041
Practice Address - Country:US
Practice Address - Phone:847-386-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK113068363L00000X, 363LG0600X
MO2023011052363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner