Provider Demographics
NPI:1518774678
Name:LUTTRELL, SAMANTHA LEANN (APRN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEANN
Last Name:LUTTRELL
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 S LIMESTONE STE L304
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-323-6494
Mailing Address - Fax:859-257-2573
Practice Address - Street 1:740 S LIMESTONE STE L304
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-6494
Practice Address - Fax:859-257-2573
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4035775363LA2100X
KY1172187163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse