Provider Demographics
NPI:1417353640
Name:CALDWELL, SAMANTHA R (APRN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:R
Last Name:CALDWELL
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 1:1550 HIGHWAY 15 S STE 240
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-0709
Mailing Address - Country:US
Mailing Address - Phone:606-824-5037
Mailing Address - Fax:
Practice Address - Street 1:1049 CENTER DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3838
Practice Address - Country:US
Practice Address - Phone:859-624-5300
Practice Address - Fax:859-624-5302
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily