Trivy Johnson, CERTIFIED HAIR LOSS

Primary specialty

Prosthetics Case ManagementTaxonomy code 1744P3200X

License

C81080 Issued in NC

Practice address

8011 N Point Blvd Ste L
Winston Salem, NC 27106-3244

Phone

(336) 310-4660

Fax

(336) 310-4660

NPI assigned

Jan 21, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1548028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653523200000",
    "number": "1548734718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N PATTERSON AVE UNIT 562",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271020157",
            "telephone_number": "336-310-4660",
            "fax_number": "336-310-4660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8011 N POINT BLVD STE L",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063244",
            "telephone_number": "336-310-4660",
            "fax_number": "336-310-4660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TRIVY",
        "credential": "CERTIFIED HAIR LOSS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-21",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1744P3200X",
            "taxonomy_group": "",
            "desc": "Specialist, Prosthetics Case Management",
            "state": "NC",
            "license": "C81080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N/A",
            "identifier": "000000000000",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "billing@ileah.org",
            "affiliation": "N",
            "address_1": "8011 N Point Blvd Ste L",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271063244",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sheila Simone Johnson, FNP
• Soren Morgan Johnson, M.D.
• Susan Davis Johnson, LBA
• Tashana Denise Johnson, CRNP
• Taylor Johnson
• Yavonne L Johnson, PA
• Curtis Brent Johnsrude, M.D.
• Ashley Catanzarite Johnston, MD
• Daniel Lee Johnston, M.D.
• Daniel Ryan Johnston, MD

• Prosthetics Case Management in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Prosthetics Case Management in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; 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.