Organization Active NPI

Dynamic Telehealth LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Fairfield, OH
National Provider Identifier
1174305965
Registry record updated Jan 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
DYNAMIC TELEHEALTH LLC
Practice address
31 Stonegate CT
Fairfield, OH 45014
Phone
(513) 302-2820
NPI assigned
Oct 17, 2023
Last updated
Jan 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2026

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

Authorized official

Name
Cheryl Anntoinette Wilkerson, CNPNPI 1801157490
Title
President
Phone
(513) 302-2820

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary

Addresses

Primary practice location

31 Stonegate CT
Fairfield, OH 45014

Mailing address

31 Stonegate CT
Fairfield, OH 45014
Phone (513) 302-2820

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251120002075 OH Part B Supplier - Clinic/Group Practice 8325530025 Receives reassigned benefits from 1 practitioner
Practice locations: Cincinnati, OH

National Provider Directory

National Provider Directory

Locations

9909 Springfield Pike
Cincinnati, OH 45215
Phone (513) 596-9822

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1697500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767916800000",
    "number": "1174305965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 STONEGATE CT",
            "city": "FAIRFIELD",
            "state": "OH",
            "postal_code": "45014",
            "telephone_number": "513-302-2820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 STONEGATE CT",
            "city": "FAIRFIELD",
            "state": "OH",
            "postal_code": "45014",
            "telephone_number": "513-302-2820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC TELEHEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-17",
        "last_updated": "2026-01-09",
        "certification_date": "2026-01-09",
        "status": "A",
        "authorized_official_last_name": "WILKERSON",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "ANNTOINETTE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "513-302-2820",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.