Provider Demographics
NPI:1154389419
Name:SAMS, HEATHER MARISA (PA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARISA
Last Name:SAMS
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARISA
Other - Last Name:HOYLE-SAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1900 S WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6755
Mailing Address - Country:US
Mailing Address - Phone:479-254-9777
Mailing Address - Fax:479-254-9729
Practice Address - Street 1:1900 S WALTON BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6755
Practice Address - Country:US
Practice Address - Phone:479-254-9777
Practice Address - Fax:479-254-9729
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA239363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP77295Medicare UPIN
AR55446-P082Medicare ID - Type Unspecified