Samantha Ronae Bumguardner, YOUTH SERVICE

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

205 J T Stites Blvd
Sallisaw, OK 74955-9323

Phone

(918) 775-7787

Fax

(918) 775-0328

NPI assigned

Oct 21, 2024

Last updated

Oct 21, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Samantha Ronae Ansani Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1013738244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 S J T STITES ST",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749559301",
            "telephone_number": "918-775-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 J T STITES BLVD",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749559323",
            "telephone_number": "918-775-7787",
            "fax_number": "918-775-0328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUMGUARDNER",
        "first_name": "SAMANTHA",
        "middle_name": "RONAE",
        "credential": "YOUTH SERVICE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-21",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "ANSANI",
            "middle_name": "RONAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Counselor in Sallisaw, OK
• Providers in Sallisaw, OK by specialty
• Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.