Active NPI
Nicole Croteau-Johnson, LPA
- Psychologist
- Wilmington, NC
National Provider Identifier
1396719712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2375
- Practice address
- 411 Chestnut St
Wilmington, NC 28401-4021 - Phone
- (910) 251-0300
- Fax
- (910) 251-0310
- NPI assigned
- Feb 14, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2375 | NC | Primary |
Addresses
Primary practice location
411 Chestnut St
Wilmington, NC 28401-4021
Mailing address
411 Chestnut St
Wilmington, NC 28401-4021
Phone (910) 251-0300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13575 | Other | NC | BLUE CROSS BLUE SHIELD |
| 6107038 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2375 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234828800000",
"number": "1396719712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 CHESTNUT ST",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284014021",
"telephone_number": "910-251-0300",
"fax_number": "910-251-0310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 CHESTNUT ST",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284014021",
"telephone_number": "910-251-0300",
"fax_number": "910-251-0310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROTEAU-JOHNSON",
"first_name": "NICOLE",
"credential": "LPA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-14",
"last_updated": "2009-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "2375",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "13575",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6107038",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.