Kristal Samuel

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

2-057363 Issued in AL

Practice address

1321 McMillan Ave
Brewton, AL 36426-1324

Phone

(251) 867-3242

Fax

(251) 867-7151

NPI assigned

Mar 24, 2011

Sex

Female

Sole proprietor

Yes

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

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.

• Southwest Alabama Behavioral Health Care Systems

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Monroeville, AL
  • NPI 1881628162
  NPD (past)

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

{
    "created_epoch": "1300924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300924800000",
    "number": "1992004329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 MCMILLAN AVE",
            "city": "BREWTON",
            "state": "AL",
            "postal_code": "364261324",
            "telephone_number": "251-867-3242",
            "fax_number": "251-867-7151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 MCMILLAN AVE",
            "city": "BREWTON",
            "state": "AL",
            "postal_code": "364261324",
            "telephone_number": "251-867-3242",
            "fax_number": "251-867-7151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "KRISTAL",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-24",
        "last_updated": "2011-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AL",
            "license": "2-057363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosewood Emergency Physicians, LLC
• Michael Daron Rowell, OTR-L
• Rural Urgent Care LLC
• Rural Urgent Care LLC
• Savannah Sheree Salter, LPN
• Santa Rosa Hma Physician Management LLC
• Sawrie Oncology Inc.
• Martha Dawn Singleton, CRNP
• Skill Builders OT Services, LLC
• Tommy Wayne Smith

• All providers in Brewton, AL
• Licensed Practical Nurse in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2011; 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.