Individual provider Active NPI

Amy Lynnae Johnson

  • Psychologist
  • Durham, NC
National Provider Identifier
1578759700
Registry record updated Aug 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
3936 Issued in NC
Practice address
2608 Erwin Rd
Durham, NC 27705-4596
Phone
(404) 754-7506
NPI assigned
Sep 21, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 3936 NC Primary

Addresses

Primary practice location

2608 Erwin Rd
Durham, NC 27705-4596

Mailing address

3400 Cedarbird Way
Durham, NC 27707-9227
Phone (404) 754-7506

Other identifiers 1

IdentifierTypeStateIssuer
6001233MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250828005573 NC Practitioner - Clinical Psychologist 5597266791 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
University of North Carolina at Chapel Hill School of Medicine, 2008
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

PO Box
Suite 110566
Durham, NC 27709

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
3936NCMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Health System, Inc. Current Accepting new patients
Duke Health Integrated Practice, Inc. CurrentSince Sep 1, 2025 Accepting new patients
Duke University Health System, Inc. CurrentSince Sep 1, 2025 Accepting new patients
Duke University Health System, Inc. CurrentSince Sep 1, 2025 Accepting new patients
The Gathering Space, LLC PastSince Sep 3, 2025 Accepting new patients

Locations

40 Duke Medicine Cir
Durham, NC 27710
Phone (919) 681-6588

2213 Elba St
Durham, NC 27705
Phone (919) 684-0100

2301 Erwin Rd
Durham, NC 27705
Phone (919) 668-0289

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756252800000",
    "number": "1578759700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 CEDARBIRD WAY",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277079227",
            "telephone_number": "404-754-7506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2608 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277054596",
            "telephone_number": "404-754-7506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "AMY",
        "middle_name": "LYNNAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-21",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "3936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6001233",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.