Cinderella Wigs & Breast Prosthetics

Key facts

NPI

1891940201

Entity type

Organization (NPI type 2)

Primary specialty

Durable Medical Equipment & Medical Supplies 332B00000X

Legal business name

CINDERELLA WIGS & BREAST PROSTHETICS

Practice address

140 Lake Dr
Tiptonville, TN 38079-1247

Phone

(731) 623-4333

Fax

(731) 623-4333

NPI assigned

Nov 26, 2008

Organization subpart

No

Authorized official

Name

Normajean Johnson, ABC / BOC NPI 1548305501

Title

Owner

Phone

(731) 623-4333

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

Practitioners 1

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

• Norma Jean Johnson, BOC ABC Orthotic Fitter · Tiptonville, TN · NPI 1548305501
  NPD (past) Authorized official

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 4, 2012.

{
    "created_epoch": "1227657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351987200000",
    "number": "1891940201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 LAKE DR.",
            "city": "TIPTONVILLE",
            "state": "TN",
            "postal_code": "380791359",
            "telephone_number": "731-623-4333",
            "fax_number": "731-623-4333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 LAKE DR",
            "city": "TIPTONVILLE",
            "state": "TN",
            "postal_code": "380791247",
            "telephone_number": "731-623-4333",
            "fax_number": "731-623-4333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CINDERELLA WIGS & BREAST PROSTHETICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-26",
        "last_updated": "2012-11-04",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "NORMAJEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-623-4333",
        "authorized_official_credential": "ABC / BOC"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENN CARE MEDICAID",
            "identifier": "1455190",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4041082",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tiptonville, TN

• Charlotte Corkran Adcock, PHARMACIST
• Misty C Barker, APN
• Astin Berry, PTA
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• Daniel W. Bruce, M.D.
• Citizens of Lake County for Health Care Inc
• Amanda Collins, PA-C
• County of Lake
• Kristen Deaton, PMHNP-BC
• Kerri A Ervin, FNP

All providers in Tiptonville, TN · Durable Medical Equipment & Medical Supplies in Tennessee