Provider Demographics
NPI:1295984367
Name:PAVLICK, SAMANTHA A (WHNP-BC, CNM, PMHNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:A
Last Name:PAVLICK
Suffix:
Gender:
Credentials:WHNP-BC, CNM, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OLD POND RD STE 107
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1269
Mailing Address - Country:US
Mailing Address - Phone:412-319-7866
Mailing Address - Fax:412-914-8635
Practice Address - Street 1:200 OLD POND RD STE 107
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1269
Practice Address - Country:US
Practice Address - Phone:412-319-7866
Practice Address - Fax:412-914-8635
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010693363LX0001X
PASP021855363LP0808X
PAMW010168367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102248230Medicaid
PASP010693OtherLICENSE NUMBER