Active NPI
Lela Kristine Dark, CRNP
- Nurse Practitioner
- Columbus, GA
National Provider Identifier
1710127261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- RN222649
- Practice address
- 1051 Talbotton Rd
Columbus, GA 31904-8745 - Phone
- (706) 322-2511
- Fax
- (706) 322-0913
- NPI assigned
- Feb 24, 2009
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 1-077179 | AL | |
| Nurse Practitioner | 363L00000X | RN222649 | GA | Primary |
Addresses
Primary practice location
1051 Talbotton Rd
Columbus, GA 31904-8745
Mailing address
1051 Talbotton Rd
Columbus, GA 31904-8745
Phone (706) 322-2511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 510-70395 | Other | AL | BLUE CROSS BLUE SHIELD |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-077179 | AL | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346976000000",
"number": "1710127261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1051 TALBOTTON RD",
"city": "COLUMBUS",
"state": "GA",
"postal_code": "319048745",
"telephone_number": "706-322-2511",
"fax_number": "706-322-0913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1051 TALBOTTON RD",
"city": "COLUMBUS",
"state": "GA",
"postal_code": "319048745",
"telephone_number": "706-322-2511",
"fax_number": "706-322-0913"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DARK",
"first_name": "LELA",
"middle_name": "KRISTINE",
"name_prefix": "Mrs.",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-02-24",
"last_updated": "2012-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "AL",
"license": "1-077179",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "GA",
"license": "RN222649",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "510-70395",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbus, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.