Individual
SAMANTHA DANIELLE STATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
129 CENTER ST STE B, RICHLAND, MS 39218-4800
(769) 233-7141
Mailing address
129 CENTER ST STE B, RICHLAND, MS 39218-4800
(769) 233-7141
(769) 233-7726
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
37098
TN
363L00000X
Nurse Practitioner
906894
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37098
STATE LICENSE
TN
01
—
906894
LICENSURE
MS
Enumeration date
07/29/2024
Last updated
09/09/2025
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