Trisha Ann Dmytruk, FNP

Primary specialty

Obstetrics PhysicianTaxonomy code 207VX0000X

License

DMYT-D80B68 Issued in NC

Practice address

11840 Southmore Dr Ste 100
Charlotte, NC 28277-4821

Phone

(704) 316-4440

Fax

(704) 316-4441

NPI assigned

Jun 27, 2017

Last updated

Jun 16, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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

• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529107200000",
    "number": "1346760675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12615 KANE ALEXANDER DR",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280783753",
            "telephone_number": "704-947-7925",
            "fax_number": "704-316-6773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11840 SOUTHMORE DR STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282774821",
            "telephone_number": "704-316-4440",
            "fax_number": "704-316-4441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DMYTRUK",
        "first_name": "TRISHA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-27",
        "last_updated": "2018-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "NC",
            "license": "DMYT-D80B68",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michelle DO
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• Obstetrics Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Obstetrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.