Samantha Roxanne Polston, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3016188 Issued in KY

Practice address

1801 Ashley Cir
Bowling Green, KY 42104-3362

Phone

(270) 793-1000

NPI assigned

Jan 18, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Zipclinic, PSC

  dba ZipClinic

  • Primary Care Clinic/Center
  • Bowling Green, KY
  • NPI 1861873507
  NPD

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

{
    "created_epoch": "1610928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624492800000",
    "number": "1033708649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 ROBIN HOOD TRL",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421014220",
            "telephone_number": "270-459-0794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 ASHLEY CIR",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421043362",
            "telephone_number": "270-793-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLSTON",
        "first_name": "SAMANTHA",
        "middle_name": "ROXANNE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-18",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KY",
            "license": "1149077",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3016188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelby Poland
• Jenna Cross Polk, RD, LD
• Pamela Pollard, COTA/L
• Frank Trevor Polson, MSCCC/SLP
• Mackenzie Polston
• Krystle Elizabeth Pope, MED, BCBA, LBA
• Stephanie Popovic, BHS
• Amanda Porter, MD
• Elizabeth Cooper Porter, OTR/L
• Grace Marie Porter, COTA

• Family Nurse Practitioner in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Family Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.