Provider Demographics
NPI:1659105930
Name:JOHNSON, SAMANTHA JANE (APRN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JANE
Other - Last Name:GROTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24319 SW 700TH RD
Mailing Address - Street 2:
Mailing Address - City:WELDA
Mailing Address - State:KS
Mailing Address - Zip Code:66091-9158
Mailing Address - Country:US
Mailing Address - Phone:620-481-1979
Mailing Address - Fax:
Practice Address - Street 1:3707 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2084
Practice Address - Country:US
Practice Address - Phone:785-270-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-83413-031363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health