Doctor Name: | SAMANTHA CHANDLER HERBERT |
NPI Number: | 1598154288 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN CNP |
License Number: | 72521 |
Business Practice Address: | 1 Choctaw Way Talihina, OK - 745712022 |
Business Phone Number: | 9185677000 |
Business Fax Number: | |
Mailing Address: | 21 Pickle Ln, HEAVENER |
State: | OK |
Postal Code: | 749379400 |
Phone Number: | 9185677000 |
Fax Number: | |
NPI Enumeration Date: | 01/18/2015 |
NPI Last Update Date: | 01/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP2300X |
License Number: | 72521 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |