Provider Demographics
NPI:1871118497
Name:STOVALL, SAMARA (PA-C)
Entity type:Individual
Prefix:
First Name:SAMARA
Middle Name:
Last Name:STOVALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SAMARA
Other - Middle Name:
Other - Last Name:JASPERSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-5687
Mailing Address - Fax:540-932-5688
Practice Address - Street 1:78 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2332
Practice Address - Country:US
Practice Address - Phone:540-932-5687
Practice Address - Fax:540-932-5688
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110007326363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant