Provider Demographics
NPI:1497478812
Name:NEUHAUS, SAMANTHA JADE (APRN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JADE
Last Name:NEUHAUS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4381 S EASON BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6584
Mailing Address - Country:US
Mailing Address - Phone:662-377-3008
Mailing Address - Fax:
Practice Address - Street 1:4381 S EASON BLVD STE 301
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6584
Practice Address - Country:US
Practice Address - Phone:662-377-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905575363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner