Active NPI
Crystal Gillyard
- Driver
- Lake Wales, FL
National Provider Identifier
1457098899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- G463104856650
- Practice address
- 219 Dinner Lake PL
Lake Wales, FL 33859-2104 - Phone
- (863) 455-6505
- NPI assigned
- May 17, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | G463104856650 | FL | Primary |
Addresses
Primary practice location
219 Dinner Lake PL
Lake Wales, FL 33859-2104
Mailing address
401 Winston Ave Apt B1
Lake Wales, FL 33853-5057
Phone (863) 605-5839
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 |
|---|---|---|---|
| G463104856650 | FL | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652745600000",
"number": "1457098899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 WINSTON AVE APT B1",
"city": "LAKE WALES",
"state": "FL",
"postal_code": "338535057",
"telephone_number": "863-605-5839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "219 DINNER LAKE PL",
"city": "LAKE WALES",
"state": "FL",
"postal_code": "338592104",
"telephone_number": "863-455-6505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLYARD",
"first_name": "CRYSTAL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-17",
"last_updated": "2022-05-17",
"certification_date": "2022-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "FL",
"license": "G463104856650",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Wales, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 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.