Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
SAMANTHA NICOLE GLENN ETHEREDGE
ActiveSAMANTHA NICOLE GLENN ETHEREDGE is a Sports Medicine healthcare provider located in PASCAGOULA, Mississippi. NPI 1386221844 is currently active in the NPPES registry. Verify at CMS.
Sports Medicine · PASCAGOULA, MS
Registration Details
- NPI Number
- 1386221844
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Mar 29, 2021 (5.3341222112682 yrs)
- Last Updated
- Sep 24, 2025
- Licenses
-
35673 (MS)3818 (AL)
Practice Information
- Address
-
3101 DENNY AVE STE 240PASCAGOULA, MS, 395815307Browse MS providers · Browse ZIP 39581
- Phone
- 2288721951
- Fax
- 2288759998
- Primary Specialty
-
Sports Medicine
207QS0010X
- Additional Specialty
- Sports Medicine
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.