Provider Demographics
NPI:1619459641
Name:SAMS, STACEY M (CNP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:M
Last Name:SAMS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
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Mailing Address - Street 1:416 COLEGATE DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9549
Mailing Address - Country:US
Mailing Address - Phone:740-374-3526
Mailing Address - Fax:740-374-3165
Practice Address - Street 1:751 STATE ROUTE 664 N UNIT A
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-9250
Practice Address - Country:US
Practice Address - Phone:740-385-9646
Practice Address - Fax:740-385-0630
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023605363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLE-00024531OtherCNP LICENSE OHIO