Provider Demographics
NPI:1689224578
Name:SAMUEL, JENNIFER (PMHNP-BC)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SHAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:517 SHADY GLEN DR APT 202
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-6229
Mailing Address - Country:US
Mailing Address - Phone:516-343-8802
Mailing Address - Fax:
Practice Address - Street 1:2004 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-7858
Practice Address - Country:US
Practice Address - Phone:406-862-1030
Practice Address - Fax:406-862-1556
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309303363LA2200X
OR10006786363LP0808X
WAAP61425969363LP0808X
MT213628363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health