Individual
SAMANTHA N. DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7979 N SHADELAND AVE, SUITE 310, INDIANAPOLIS, IN 46250-2042
(317) 621-3780
(317) 621-3088
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001495A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201184040
OPR
IN
05
—
300007171
—
IN
01
—
P01261825
MEDICARE RR PTAN
IN
Enumeration date
05/02/2013
Last updated
11/27/2023
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