Carolyn Ann Gilley

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Practice address

220 Carroll St
Random Lake, WI 53075-1795

Phone

(800) 490-3146

NPI assigned

Jun 7, 2017

Last updated

Jun 7, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496793600000",
    "number": "1043749617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 CARROLL ST",
            "city": "RANDOM LAKE",
            "state": "WI",
            "postal_code": "530751795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 CARROLL ST",
            "city": "RANDOM LAKE",
            "state": "WI",
            "postal_code": "530751795",
            "telephone_number": "800-490-3146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLEY",
        "first_name": "CAROLYN",
        "middle_name": "ANN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-07",
        "last_updated": "2017-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Cabell, M.S. CCC-SLP
• Jamie L. Carter, OTR
• Nichole M. Cruz, O.D.
• Michelle L Feierstein, OTR
• Generations Family Dental Care-Random Lake, LLC
• Michelle M Grace-Jensen, PT
• Megan C Horn, OTR
• Ideal Chiropractic
• Jensen Interhealth (PT Connections)
• Kathleen Mary Kohlbeck, OTR

• Primary Care Clinic/Center in Random Lake, WI
• Providers in Random Lake, WI by specialty
• Primary Care Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2017; 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.