Individual provider Active NPI

Samantha Fresia Johnson, CNP

  • Nurse Practitioner
  • Athens, OH
National Provider Identifier
1619710563
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
0036739 Issued in OH
Practice address
2131 E State St
Athens, OH 45701-2138
Phone
(740) 589-3100
Fax
(740) 566-4014
NPI assigned
Jun 18, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 0036739 OH Primary

Addresses

Primary practice location

2131 E State St
Athens, OH 45701-2138

Mailing address

100 Jackson Pike
Gallipolis, OH 45631-1560
Phone (740) 446-5000

Other names 1

  • Samantha Lyall Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address samantha.johnson1@17389.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240923001026 OH Practitioner - Nurse Practitioner 7719428341 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0036739OHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Holzer Clinic, LLC CurrentSince Aug 12, 2024 Accepting new patients
I Path LLC Current Accepting new patients

Locations

2131 E State St
Athens, OH 45701
Phone (740) 589-3100

90 Jackson Pike
Gallipolis, OH 45631
Phone (740) 446-5131

100 Jackson Pike
Gallipolis, OH 45631
Phone (740) 446-5050

280 Pattonsville Rd
Jackson, OH 45640
Phone (740) 395-8805

88 E Memorial Dr
Pomeroy, OH 45769
Phone (740) 992-0060

Interoperability endpoints

  • Direct secure messaging: samantha.johnson.1@17389.direct.athenahealth.com
  • Direct secure messaging: samantha.johnson1@17389.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1619710563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 JACKSON PIKE",
            "city": "GALLIPOLIS",
            "state": "OH",
            "postal_code": "456311560",
            "telephone_number": "740-446-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 E STATE ST",
            "city": "ATHENS",
            "state": "OH",
            "postal_code": "457012138",
            "telephone_number": "740-589-3100",
            "fax_number": "740-566-4014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SAMANTHA",
        "middle_name": "FRESIA",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-18",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "0036739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "samantha.johnson1@17389.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "2131 E State St",
            "city": "Athens",
            "state": "OH",
            "country_code": "US",
            "postal_code": "457012138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "LYALL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Athens, OH

Sources for this page

Verify at the official NPI Registry.