Healthcare Provider Details

I. General information

NPI: 1659105930
Provider Name (Legal Business Name): SAMANTHA JANE JOHNSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA JANE GROTHER

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 SW 3RD ST UNIT 1A
TOPEKA KS
66606-2438
US

IV. Provider business mailing address

24319 SW 700TH RD
WELDA KS
66091-9158
US

V. Phone/Fax

Practice location:
  • Phone: 785-270-4630
  • Fax: 785-270-4628
Mailing address:
  • Phone: 620-481-1979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number83413
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-83413
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: