Provider Demographics
NPI:1780108456
Name:CROUCH, SAMANTHA CORRAL (CNM)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:CORRAL
Last Name:CROUCH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SAMANATH
Other - Middle Name:B
Other - Last Name:CORRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:4301 W MARKHAM ST # 783
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-526-5148
Practice Address - Street 1:4301 W MARKHAM ST # 518
Practice Address - Street 2:5TH FLOOR UNIT E5
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-526-0564
Practice Address - Fax:501-526-0599
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARM002133367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARM002133OtherARKANSAS STATE BOARD OF NURSING
ARR104356OtherARKANSAS STATE BOARD OF NURSING