Provider Demographics
NPI:1316157068
Name:TODD, SAMANTHA ANN (APRN)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ANN
Last Name:TODD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 S LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0582
Mailing Address - Country:US
Mailing Address - Phone:859-323-5823
Mailing Address - Fax:
Practice Address - Street 1:830 S LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0582
Practice Address - Country:US
Practice Address - Phone:859-323-5823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily