Provider Demographics
NPI:1326833211
Name:STABLES, SAMANTHA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:STABLES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 BROWNS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LERONA
Mailing Address - State:WV
Mailing Address - Zip Code:25971-9518
Mailing Address - Country:US
Mailing Address - Phone:304-890-3802
Mailing Address - Fax:
Practice Address - Street 1:565 BROWNS RIDGE RD
Practice Address - Street 2:
Practice Address - City:LERONA
Practice Address - State:WV
Practice Address - Zip Code:25971-9518
Practice Address - Country:US
Practice Address - Phone:304-890-3802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant