Charles Keith Vineyard

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

043072027 Issued in IL

Practice address

608 Rollie Moore Dr
Harrisburg, IL 62946-2351

Phone

(618) 252-6150

NPI assigned

Dec 14, 2022

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 14, 2022.

{
    "created_epoch": "1670976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670976000000",
    "number": "1558073189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 ROLLIE MOORE DR",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629462351",
            "telephone_number": "618-252-6150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 ROLLIE MOORE DR",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629462351",
            "telephone_number": "618-252-6150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINEYARD",
        "first_name": "CHARLES",
        "middle_name": "KEITH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-12-14",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IL",
            "license": "043072027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Harrisburg, IL
• Licensed Practical Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 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.