Provider Demographics
NPI:1992503205
Name:GROSS, SAMANTHA KAY (RN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KAY
Last Name:GROSS
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:SAMANTH
Other - Middle Name:KAY
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 COSWALD CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-1762
Mailing Address - Country:US
Mailing Address - Phone:757-234-5223
Mailing Address - Fax:
Practice Address - Street 1:109 COSWALD CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-1762
Practice Address - Country:US
Practice Address - Phone:757-234-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14083256163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care