Samantha Ann Archibong, CRNP-PMH

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R219787 Issued in MD

Practice address

300 E Madison St
Baltimore, MD 21202-4260

Phone

(414) 930-1830

NPI assigned

Dec 19, 2016

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1482105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484438400000",
    "number": "1730623232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MADISON ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212024260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E MADISON ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212024260",
            "telephone_number": "414-930-1830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARCHIBONG",
        "first_name": "SAMANTHA",
        "middle_name": "ANN",
        "credential": "CRNP-PMH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-19",
        "last_updated": "2017-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP013709",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R219787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Archibald Optimal Health Services, LLC
• Archibald Optimal Health Services, LLC
• Paul Clifford Archibald, MA, LCSW-C
• Jamie Archibong, M.A.
• Eyamba Archibong, LCSW-C
• Vivian Archibong, LCSW-C
• Kendarae Archie
• Terrell Devonne Archie
• Ard Behavioral Health
• Ard Behavioral Health

• Psychiatric/Mental Health Nurse Practitioner in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2017; 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.