Active NPI
Lyndera Vickland, LMT
- Pain Medicine Physician
- Virginia Beach, VA
National Provider Identifier
1174188478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pain Medicine Physician
- License
- 0019016556
- Practice address
- 1248 Gunn Hall Dr Ste 102
Virginia Beach, VA 23454-5757 - Phone
- (757) 637-0189
- NPI assigned
- May 2, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 0019016556 | VA | |
| Pain Medicine Physician | 208VP0000X | 0019016556 | VA | Primary |
Addresses
Primary practice location
1248 Gunn Hall Dr Ste 102
Virginia Beach, VA 23454-5757
Mailing address
4021 Foxwood Dr
Virginia Beach, VA 23462-5210
Phone (757) 267-5877
Other practice location 1
5002 Jefferson Ave
Newport News, VA 23605-3204
Phone (757) 637-0189
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0019016556 | Other | VA | VA BOARD OF NURSING DEPARTMENT OF HEALTH PROFESSIONS |
| 11741888478 | Medicaid | VA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0019016556 | VA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621900800000",
"number": "1174188478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4021 FOXWOOD DR",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234625210",
"telephone_number": "757-267-5877"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1248 GUNN HALL DR STE 102",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234545757",
"telephone_number": "757-637-0189"
}
],
"practiceLocations": [
{
"address_1": "5002 Jefferson Ave",
"address_purpose": "LOCATION",
"city": "Newport News",
"state": "VA",
"postal_code": "236053204",
"country_code": "US",
"telephone_number": "757-637-0189",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VICKLAND",
"first_name": "LYNDERA",
"name_prefix": "Mrs.",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-02",
"last_updated": "2021-05-25",
"certification_date": "2021-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "VA",
"license": "0019016556",
"primary": false
},
{
"code": "208VP0000X",
"taxonomy_group": "",
"desc": "Pain Medicine, Pain Medicine",
"state": "VA",
"license": "0019016556",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VA BOARD OF NURSING DEPARTMENT OF HEALTH PROFESSIONS",
"identifier": "0019016556",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "11741888478",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.