Provider Demographics
NPI:1609436922
Name:MCKINNON, SAMANTHA (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18411 CRENSHAW BLVD STE 360
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18411 CRENSHAW BLVD STE 360
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-5060
Practice Address - Country:US
Practice Address - Phone:213-340-2613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12707814-3102163W00000X
CO1686036163W00000X
MDT20230052163W00000X
CA95308835163W00000X
NY352966363LF0000X
CA95023202363LP0808X, 363LF0000X
FL11019305363LF0000X
COC-APN.0003288-C-NP363LF0000X
MDAC003943363LF0000X
TXAP142077363LF0000X
WAAP61224221363LF0000X
UT12707814-4405363LF0000X
IAA165389363LF0000X
NV877963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily