Basic Information
| Provider Information | |||||||||
| NPI: | 1154389419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAMS | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | MARISA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | P.A. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HOYLE-SAMS | ||||||||
| OtherFirstName: | HEATHER | ||||||||
| OtherMiddleName: | MARISA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | P.A. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3101 SE 14TH ST | ||||||||
| Address2: | |||||||||
| City: | BENTONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727124900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796312100 | ||||||||
| FaxNumber: | 4796360371 | ||||||||
| Practice Location | |||||||||
| Address1: | 3101 SE 14TH ST | ||||||||
| Address2: | |||||||||
| City: | BENTONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727124900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796312100 | ||||||||
| FaxNumber: | 4796360371 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | X | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA239 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.