Provider Demographics
NPI:1215596192
Name:SAMPSON, STEPHANIE MICHELLE (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84323-0245
Mailing Address - Country:US
Mailing Address - Phone:435-990-4282
Mailing Address - Fax:435-355-3718
Practice Address - Street 1:682 S MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6568
Practice Address - Country:US
Practice Address - Phone:435-990-4282
Practice Address - Fax:435-355-3718
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7734927-4405363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID833011825OtherSTATE
ID1205300407OtherGROUP NPI