Provider Demographics
NPI:1427664614
Name:EMRY, SAMANTHA J (AGACNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:EMRY
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3050
Mailing Address - Country:US
Mailing Address - Phone:573-348-8399
Mailing Address - Fax:573-348-8309
Practice Address - Street 1:1229 DEADRA DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-4669
Practice Address - Country:US
Practice Address - Phone:417-322-6460
Practice Address - Fax:774-403-5908
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020031329363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care