Provider Demographics
NPI:1740088475
Name:WHITE, SAMANTHA KAYE (CNP)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:KAYE
Last Name:WHITE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:KAYE
Other - Last Name:WAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:814 E MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5537
Mailing Address - Country:US
Mailing Address - Phone:505-868-3311
Mailing Address - Fax:
Practice Address - Street 1:400 MILITARY HEIGHTS PL
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-6407
Practice Address - Country:US
Practice Address - Phone:575-627-9500
Practice Address - Fax:575-627-9535
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM64614163W00000X
NMCNP64614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse