Individual provider Active NPI

Kalyn Prescott, LPN

  • Licensed Practical Nurse
  • Stone Mountain, GA
National Provider Identifier
1114653177
Registry record updated Jul 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
101151 Issued in GA
Practice address
1607 Barrington VW
Stone Mountain, GA 30087-1846
Phone
(678) 582-9317
NPI assigned
Jul 30, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical NurseGroup: 193400000X SINGLE SPECIALTY GROUP 164W00000X 101151 GA Primary

Addresses

Primary practice location

1607 Barrington VW
Stone Mountain, GA 30087-1846

Mailing address

1607 Barrington VW
Stone Mountain, GA 30087-1846
Phone (678) 582-9317

Other identifiers 1

IdentifierTypeStateIssuer
9576376OtherGACIGNA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address admin@royalcareservice.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1659139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659139200000",
    "number": "1114653177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1607 BARRINGTON VW",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300871846",
            "telephone_number": "678-582-9317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1607 BARRINGTON VW",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300871846",
            "telephone_number": "678-582-9317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRESCOTT",
        "first_name": "KALYN",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-30",
        "last_updated": "2022-07-30",
        "certification_date": "2022-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "GA",
            "license": "101151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "9576376",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@royalcareservice.org",
            "affiliation": "N",
            "address_1": "1607 Barrington Vw",
            "city": "Stone Mountain",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300871846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Stone Mountain, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2022; 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.