Provider Demographics
NPI:1427664614
Name:EMRY, SAMANTHA J (AGACNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:EMRY
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SPENCER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-8406
Mailing Address - Country:US
Mailing Address - Phone:573-410-1449
Mailing Address - Fax:
Practice Address - Street 1:106 W US HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-6945
Practice Address - Country:US
Practice Address - Phone:573-410-1449
Practice Address - Fax:888-348-7379
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020031329363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care