Provider Demographics
NPI:1780263194
Name:SKINNER, SAMANTHA DRAKE (DO)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DRAKE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S ROGERS RD APT A6
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6356
Mailing Address - Country:US
Mailing Address - Phone:205-983-0917
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 540
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-5341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-04
Last Update Date:2021-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program