Provider Demographics
NPI:1962741223
Name:MCGILL, SAMANTHA BURCH (NP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:BURCH
Last Name:MCGILL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ANNE
Other - Last Name:BURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1278 OCEAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3409
Mailing Address - Country:US
Mailing Address - Phone:228-875-3606
Mailing Address - Fax:
Practice Address - Street 1:1278 OCEAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3409
Practice Address - Country:US
Practice Address - Phone:228-875-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR861352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily