Provider Demographics
NPI:1619786043
Name:GASTON, SAMANTHA TENILLE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:TENILLE
Last Name:GASTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 W 39TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-8284
Mailing Address - Country:US
Mailing Address - Phone:308-870-6129
Mailing Address - Fax:
Practice Address - Street 1:2022 W 39TH ST APT 1
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-8284
Practice Address - Country:US
Practice Address - Phone:308-870-6129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant