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Individual

MRS. SAMANTHA YATES NUCKOLS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
11445 OLIVE BLVD, CREVE COEUR, MO 63141-7108
(314) 428-9543
(314) 428-9542
Mailing address
115 JAMESON WAY, SEVEN FIELDS, PA 16046-4325
(757) 406-9172

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110-004588
VA
363A00000X
Physician Assistant
Primary
2017044296
MO
363A00000X
Physician Assistant

Other

Enumeration date
07/02/2014
Last updated
09/24/2019
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