Provider Demographics
NPI:1164985099
Name:CARNEY, SAMANTHA KAY (AGPCNP-BC)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:KAY
Last Name:CARNEY
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:KAUFFMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:35318 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60678-1353
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:3900 W 203RD ST
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1183
Practice Address - Country:US
Practice Address - Phone:708-855-7069
Practice Address - Fax:708-503-3224
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008948A363LA2200X
IL209031249363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health