Samuel Wildmon, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RO92909 Issued in AR

Practice address

74 Cleburne Park Rd
Heber Springs, AR 72543-9106

Phone

(501) 362-0943

NPI assigned

Apr 1, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

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.

• Community School of Cleburne County

  • Developmentally Disabled Services Day Training Agency
  • Heber Springs, AR
  • NPI 1750596268
  NPD (past)

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

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711929600000",
    "number": "1467203984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 CLEBURNE PARK RD",
            "city": "HEBER SPRINGS",
            "state": "AR",
            "postal_code": "725439106",
            "telephone_number": "501-362-0943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 CLEBURNE PARK RD",
            "city": "HEBER SPRINGS",
            "state": "AR",
            "postal_code": "725439106",
            "telephone_number": "501-362-0943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDMON",
        "first_name": "SAMUEL",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-01",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AR",
            "license": "RO92909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• White County Medical Center
• White River Health System, Inc.
• Tyler R Whiteaker, OTR/L
• Aimee Elizabeth Widner, M.D.
• Karly Wilcox, OTR/L
• Kristen L Williams, OTR/L
• Leslie Rose Williams, APRN
• Manichanh Nikki Williams, APN
• Sandra Lynn Williams, LCSW
• Cody Willis, LPC

• Registered Nurse in Heber Springs, AR
• Providers in Heber Springs, AR by specialty
• Registered Nurse in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 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.