Provider Demographics
NPI:1518769058
Name:BLY, SAMANTHA (PMHNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BLY
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 W 146TH TER APT 1101
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3830
Mailing Address - Country:US
Mailing Address - Phone:210-249-8199
Mailing Address - Fax:
Practice Address - Street 1:7500 W 160TH ST STE 201
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:KS
Practice Address - Zip Code:66085-8100
Practice Address - Country:US
Practice Address - Phone:913-392-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1193541363LP0808X
KS53-84261-081363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health