IndividualActive
Samuel Johnson, NP
NPI 1639969637 · Acute Care Nurse Practitioner · Idaho Falls, ID
Provider details
- NPI number
- 1639969637
- Entity type
- Individual
- Primary specialty
- Acute Care Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- NP
- Sex
- Male
- Sole proprietor
- No
- License
- 4471358 (ID)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
3100 Channing Way
Idaho Falls, ID 83404-7533
Phone: (801) 499-1889
Approximate (ZIP-level) locationGet directions
Mailing address
3100 Channing Way
Idaho Falls, ID 83404-7533
Registry dates
- Enumerated
- 2025-05-12
- Last updated
- 2025-05-12
- Certified
- 2025-05-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.