Individual provider Active NPI

Lauren Alana Gillingham

  • Psychiatric/Mental Health Nurse Practitioner
  • Derby, CT
National Provider Identifier
1063287779
Registry record updated Jul 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
12.015007 Issued in CT
Practice address
248 Seymour Ave
Derby, CT 06418-1332
Phone
(203) 732-7550
Fax
(203) 732-1550
NPI assigned
Nov 22, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X 129031 CT
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 12.015007 CT Primary

Addresses

Primary practice location

248 Seymour Ave
Derby, CT 06418-1332

Mailing address

248 Seymour Ave
Derby, CT 06418-1332
Phone (203) 732-7550

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250917002308 CT Practitioner - Nurse Practitioner 2961906565 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Griffin HospitalGroup PAC ID 8921901984, 24 clinicians

Practice addresses (Care Compare)

130 Division St
Derby, CT 06418-1326
Phone (203) 732-7360

Hospital & facility affiliations

  • Griffin Hospital Hospital, Derby, CT, CCN 070031

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
129031CTMDPsychiatric/Mental Health Registered Nurse
12.015007CTMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Griffin Hospital CurrentSince Aug 18, 2025 Accepting new patients

Locations

248 Seymour Ave
Derby, CT 06418
Phone (203) 732-7550

130 Division St
Derby, CT 06418
Phone (203) 732-1330

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1700611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752451200000",
    "number": "1063287779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "248 SEYMOUR AVE",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181332",
            "telephone_number": "203-732-7550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "248 SEYMOUR AVE",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181332",
            "telephone_number": "203-732-7550",
            "fax_number": "203-732-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLINGHAM",
        "first_name": "LAUREN",
        "middle_name": "ALANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-22",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CT",
            "license": "129031",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "12.015007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Derby, CT

Sources for this page

Verify at the official NPI Registry.