Provider Demographics
NPI:1316613391
Name:DAVIS, SAMANTHA DAWN
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DAWN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 RIVERSIDE DR
Mailing Address - Street 2:APT 9
Mailing Address - City:WARFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:41267
Mailing Address - Country:US
Mailing Address - Phone:606-373-5443
Mailing Address - Fax:
Practice Address - Street 1:48 RIVERSIDE DR
Practice Address - Street 2:APT 9
Practice Address - City:WARFIELD
Practice Address - State:KY
Practice Address - Zip Code:41267
Practice Address - Country:US
Practice Address - Phone:606-373-5443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant