Kristal Sue Wilmes

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D13982 Issued in MN

Practice address

197 N Tyler St
Tyler, MN 56178-1160

Phone

(507) 380-0127

NPI assigned

May 14, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Tyler Family Dental PLLC

  • Clinic/Center
  • Tyler, MN
  • NPI 1568162733
  NPD Authorized official

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

{
    "created_epoch": "1526256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526256000000",
    "number": "1982194098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "197 N TYLER ST",
            "city": "TYLER",
            "state": "MN",
            "postal_code": "561781160",
            "telephone_number": "507-380-0127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "197 N TYLER ST",
            "city": "TYLER",
            "state": "MN",
            "postal_code": "561781160",
            "telephone_number": "507-380-0127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILMES",
        "first_name": "KRISTAL",
        "middle_name": "SUE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-14",
        "last_updated": "2018-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D13982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler Healthcare Center Dba Tyler Healthcare Pharmacy
• Marissa Rae Tyler, DC
• John Rice Utoft, DDS
• Candice Lou Vanderplaats, RN CNP
• Luann Elizabeth Weber, PA-C

• All providers in Tyler, MN
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2018; 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.