Healthcare Provider Details

I. General information

NPI: 1194947259
Provider Name (Legal Business Name): JENNIE BYRNE MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIE JOHNSON M.D., PH.D.

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 ROCK CREEK RD
CHAPEL HILL NC
27514-6714
US

IV. Provider business mailing address

643 ROCK CREEK RD
CHAPEL HILL NC
27514-6714
US

V. Phone/Fax

Practice location:
  • Phone: 919-428-5154
  • Fax: 919-910-5488
Mailing address:
  • Phone: 919-428-5154
  • Fax: 919-910-5488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number145081
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number59654
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number59654
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number145081
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: