Provider Demographics
NPI:1801788104
Name:DOUGLAS, SAMANTHA JANIECE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANIECE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JANIECE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2359 KREBS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-2773
Mailing Address - Country:US
Mailing Address - Phone:918-916-7142
Mailing Address - Fax:
Practice Address - Street 1:601 E CARL ALBERT PKWY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5113
Practice Address - Country:US
Practice Address - Phone:918-233-6522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-19
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK224848363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner