Provider Demographics
NPI:1538955232
Name:KPECHI, SAMUEL (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:KPECHI
Suffix:
Gender:
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5532 PERKINS CIR
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1728
Mailing Address - Country:US
Mailing Address - Phone:443-600-6071
Mailing Address - Fax:443-525-8766
Practice Address - Street 1:5532 PERKINS CIRCLE
Practice Address - Street 2:
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162
Practice Address - Country:US
Practice Address - Phone:443-600-6071
Practice Address - Fax:443-525-8766
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR249981163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD883181915Medicaid
MD224227300Medicaid