Provider Demographics
NPI:1548459019
Name:SAMUEL, EUREKIA C (NP)
Entity type:Individual
Prefix:MRS
First Name:EUREKIA
Middle Name:C
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1668 W PEACE ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-5332
Mailing Address - Country:US
Mailing Address - Phone:601-936-3833
Mailing Address - Fax:601-936-3837
Practice Address - Street 1:4635 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4226
Practice Address - Country:US
Practice Address - Phone:601-936-3833
Practice Address - Fax:601-936-3837
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR860068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06781511Medicaid