| Divinity Healthcare Inc | |
|
99 Winchester Dr Unit K West Point MS 39773-2083 | |
| (662) 848-3656 | |
| Not Available |
| Full Name | Divinity Healthcare Inc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 99 Winchester Dr Unit K, West Point, Mississippi |
| Authorized Official Name and Position | Trinity Sharda Johnson (OWNER) |
| Authorized Official Contact | 6628483656 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divinity Healthcare Inc 99 Winchester Dr Unit K West Point MS 39773-2083 Ph: (662) 848-3656 | Divinity Healthcare Inc 99 Winchester Dr Unit K West Point MS 39773-2083 Ph: (662) 848-3656 |
| NPI Number | 1396567301 |
|---|---|
| Provider Enumeration Date | 10/30/2024 |
| Last Update Date | 04/07/2025 |
| Certification Date | 04/07/2025 |
| Medicare PECOS PAC ID | 0042746166 |
|---|---|
| Medicare Enrollment ID | O20250617003344 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396567301 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Secondary |
| 363LF0000X | Nurse Practitioner - Family | () | Primary |
| Provider Name | Trinity Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427785849 PECOS PAC ID: 5799296679 Enrollment ID: I20250617003536 |
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