Provider Demographics
NPI:1679164016
Name:MATTHEWS, SAMANTHA LYNN (APRN)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LYNN
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 STATE HWY 44
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165
Mailing Address - Country:US
Mailing Address - Phone:502-215-8422
Mailing Address - Fax:
Practice Address - Street 1:340 STATE HIGHWAY 44
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165
Practice Address - Country:US
Practice Address - Phone:502-215-8422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015169363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily