Provider Demographics
NPI:1437674454
Name:ARNOLD, SAMMY LANE
Entity type:Individual
Prefix:
First Name:SAMMY
Middle Name:LANE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMMY
Other - Middle Name:LANE
Other - Last Name:RADCLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:15265 PRIVATE DRIVE 1122
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-7835
Mailing Address - Country:US
Mailing Address - Phone:844-464-0731
Mailing Address - Fax:573-426-2108
Practice Address - Street 1:15265 PRIVATE DRIVE 1122
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-7835
Practice Address - Country:US
Practice Address - Phone:844-464-0731
Practice Address - Fax:573-426-2108
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017028760207Q00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine