Healthcare Provider Details

I. General information

NPI: 1598600892
Provider Name (Legal Business Name): SAMANTHA JOHNSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 S TELSHOR BLVD
LAS CRUCES NM
88011-5076
US

IV. Provider business mailing address

6006 BALCONES CT APT 1
EL PASO TX
79912-3340
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-8641
  • Fax:
Mailing address:
  • Phone: 501-802-5997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1232108
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: