Provider Demographics
NPI:1568291672
Name:BROWDER, SAMANTHA DANIELLE (NP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DANIELLE
Last Name:BROWDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:DANIELLE
Other - Last Name:WIGINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:111 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2313
Mailing Address - Country:US
Mailing Address - Phone:731-989-2829
Mailing Address - Fax:731-520-0230
Practice Address - Street 1:702 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:TN
Practice Address - Zip Code:38052-3615
Practice Address - Country:US
Practice Address - Phone:731-837-5028
Practice Address - Fax:731-837-5027
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37098363L00000X
MS0000000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN37098OtherSTATE LICENSE