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Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

MR. SAMUEL THACKSTON
NPI 1063311736
Student in an Organized Health Care Education/Training Program in Newberg, OR

Active since November 02, 2026
448 N WERTH BLVD, NEWBERG, OR 97132(503) 554-2521(503) 554-3466 Get Directions Write a Review

NPPES record added: November 2, 2026. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Mr. Samuel Thackston NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. SAMUEL THACKSTON (NPI 1063311736) is an individual student in an organized health care education/training program in Newberg, Oregon and active in the NPI registry since November 2026.

NPPES Registry Identity

NPI1063311736
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameMR. SAMUEL THACKSTON
Location Address448 N WERTH BLVDNewberg, OR 97132-7500
Mailing Address8818 N Prescott RdSpokane, WA 99208-8899 · (503) 554-2521 · Fax (503) 554-3466
Phone(503) 554-2521
Fax(503) 554-3466
Sole ProprietorNo
Enumeration DateNovember 2, 2026
NPPES CertifiedNovember 1, 2026
✔ NPI 1063311736 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
448 N WERTH BLVD, Newberg, OR 97132
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRITNY CRISTINA RUILOVA TELLEZ
Physician Assistant
448 N WERTH BLVD
NEWBERG, OR 97132
Yamhill County (949) 929-1906
NIRA AVARI
Student in an Organized Health Care Education/Training Program
448 N WERTH BLVD
NEWBERG, OR 97132
Yamhill County (503) 554-2521
MADELYN ROSE KENNEDY
Student in an Organized Health Care Education/Training Program
448 N WERTH BLVD
NEWBERG, OR 97132
Yamhill County (503) 554-2521
JOHN PHUOC HUYNH DO
Physician Assistant
448 N WERTH BLVD
NEWBERG, OR 97132
Yamhill County (503) 538-8383
COURTNEY MARIE FISHER
Student in an Organized Health Care Education/Training Program
448 N WERTH BLVD
NEWBERG, OR 97132
Yamhill County (503) 554-2521
MCKINLEY AARON GILLUM
Student in an Organized Health Care Education/Training Program
448 N WERTH BLVD
NEWBERG, OR 97132
Yamhill County (503) 538-8383
LILLIAN MAY PARKS
Student in an Organized Health Care Education/Training Program
448 N WERTH BLVD
NEWBERG, OR 97132
Yamhill County (503) 554-2521
AMELIA SARAH TESULOV
Student in an Organized Health Care Education/Training Program
448 N WERTH BLVD
NEWBERG, OR 97132
Yamhill County (503) 538-8383

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Samuel Thackston's NPI number?

The NPI number for Samuel Thackston is 1063311736. It was assigned to this individual provider in the NPPES registry on November 2, 2026.

Where is Samuel Thackston located?

Samuel Thackston practices at 448 N Werth Blvd, Newberg, OR 97132. The listed phone number is (503) 554-2521.

What is Samuel Thackston's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Samuel Thackston was last updated on November 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.