Provider Demographics
NPI:1699496190
Name:PRENTICE, SAMANTHA KATE
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:KATE
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SAMANTHA
Other - Middle Name:KATE
Other - Last Name:COZORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2463 NW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8720
Mailing Address - Country:US
Mailing Address - Phone:405-885-3739
Mailing Address - Fax:
Practice Address - Street 1:2463 NW 42ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8720
Practice Address - Country:US
Practice Address - Phone:405-885-3739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator