Provider Demographics
NPI:1396297495
Name:BARRY, SAMANTHA NICHOLS (APRN)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:NICHOLS
Last Name:BARRY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:E
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:859-276-8400
Mailing Address - Fax:859-276-3700
Practice Address - Street 1:1401 HARRODSBURG RD STE C305
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3771
Practice Address - Country:US
Practice Address - Phone:859-276-8400
Practice Address - Fax:859-276-3700
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100435440Medicaid