Organization Active NPI

Divinity Healthcare Inc

  • Family Nurse Practitioner
  • West Point, MS
National Provider Identifier
1396567301
Registry record updated Apr 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
DIVINITY HEALTHCARE INC
Practice address
99 Winchester Dr Unit K
West Point, MS 39773-2083
Phone
(662) 848-3656
NPI assigned
Oct 30, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2025

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

Authorized official

Name
Mrs. Trinity Sharda Johnson, FNPNPI 1427785849
Title
Owner
Phone
(662) 848-3656

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

99 Winchester Dr Unit K
West Point, MS 39773-2083

Mailing address

99 Winchester Dr Unit K
West Point, MS 39773-2083
Phone (662) 848-3656

Other names 1

  • DIVINITY HEALTHCARE INC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250617003344 MS Part B Supplier - Clinic/Group Practice 0042746166 Receives reassigned benefits from 1 practitioner
Practice locations: West Point, MS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2327159Divinity Healthcare Inc99 Winchester Dr Unit K, West Point, MS 39773Certificate of waiverJul 16, 2027

National Provider Directory

National Provider Directory

Locations

99 Winchester Dr
Unit K
West Point, MS 39773
Phone (662) 524-3707

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1730246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743984000000",
    "number": "1396567301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 WINCHESTER DR UNIT K",
            "city": "WEST POINT",
            "state": "MS",
            "postal_code": "397732083",
            "telephone_number": "662-848-3656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 WINCHESTER DR UNIT K",
            "city": "WEST POINT",
            "state": "MS",
            "postal_code": "397732083",
            "telephone_number": "662-848-3656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINITY HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-30",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TRINITY",
        "authorized_official_middle_name": "SHARDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-848-3656",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DIVINITY HEALTHCARE INC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DIVINITY HEALTHCARE INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Point, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.