Crystal Lynne Tillman, DNP, CPNP, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

300186 Issued in NC

Practice address

1055 Dresser CT
Raleigh, NC 27609-7323

Phone

(919) 876-3130

NPI assigned

Dec 28, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina Partners in Mental

  • Non-Pharmacy Dispensing Site
  • Raleigh, NC
  • NPI 1861810715
  NPD (past)

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

{
    "created_epoch": "1356652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445990400000",
    "number": "1609112333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 BRYAN ST",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276051104",
            "telephone_number": "704-906-1428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 DRESSER CT",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097323",
            "telephone_number": "919-876-3130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "CRYSTAL",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "DNP, CPNP, PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-12-28",
        "last_updated": "2015-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "300186",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "300186",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSING AND MEDICAL BOARD PRESCRIBING NUMBER",
            "identifier": "300186",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane S Tilley, FNP-BC
• Lyndzee Tilley, CRC, LCMHC-A
• Marilee Marshall Tilley, CRNA
• Gabrielle Denise Tillison
• Shelia Tillitt, LPN
• Elizabeth Cuervo Tilson, M.D.
• Richard Walter Chan Tim, M.D.
• Bonita Ann Timan, NCBTMT
• Rachel Carolyn Timberlake, DDS
• Phillip Zachary Timmons, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; 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.