Vernice Dolores Gallon Clyburn, LRT/CTRS

Primary specialty

Recreation TherapistTaxonomy code 225800000X

License

1702 Issued in NC

Practice address

126 S Rose Ave
Kannapolis, NC 28083-3552

Phone

(704) 938-9657

NPI assigned

Jul 6, 2017

Last updated

Mar 15, 2021By the provider in NPPES

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 names 1

• Vernice Dolores Gallon Former name

Electronic endpoints 1

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.

{
    "created_epoch": "1499299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1962923474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 S ROSE AVE",
            "city": "KANNAPOLIS",
            "state": "NC",
            "postal_code": "280833552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 S ROSE AVE",
            "city": "KANNAPOLIS",
            "state": "NC",
            "postal_code": "280833552",
            "telephone_number": "704-938-9657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLON CLYBURN",
        "first_name": "VERNICE",
        "middle_name": "DOLORES",
        "credential": "LRT/CTRS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-06",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225800000X",
            "taxonomy_group": "",
            "desc": "Recreation Therapist",
            "state": "NC",
            "license": "19360",
            "primary": false
        },
        {
            "code": "225800000X",
            "taxonomy_group": "",
            "desc": "Recreation Therapist",
            "state": "NC",
            "license": "1702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "laptop",
            "affiliation": "N",
            "address_1": "126 S Rose Ave",
            "city": "Kannapolis",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280833552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "VERNICE",
            "last_name": "GALLON",
            "middle_name": "DOLORES",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Recreation Therapist in Kannapolis, NC
• Providers in Kannapolis, NC by specialty
• Recreation Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; 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.