DR. CRYSTAL LYNNE TILLMAN (NPI# 1609112333) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609112333 |
| Entity Type | Individual |
| Full Name | DR. CRYSTAL LYNNE TILLMAN |
| Credential | DNP, CPNP, PMHNP-BC |
| Practice Address |
1055 Dresser Ct Raleigh NC 27609-7323 |
| Mailing Address |
830 Bryan St Raleigh NC 27605-1104 |
| Practice Telephone | 9198763130 |
| Mailing Telephone | 7049061428 |
| Enumeration Date | 2012-12-28 |
| Last Update Date | 2015-10-28 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
300186 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
300186 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | NURSING AND MEDICAL BOARD PRESCRIBING NUMBER | 300186 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942660691 | Crystal Tillman | Licensed Practical Nurse | 56550 Hartley Dr W, Shelby Township, MI 48316-5569 | 2016-02-23 |
| 1588067631 | Crystal M. Tillman | Counselor | 100 North Street First Floor South Bay Mental Health, Pittsfield Outreach Program Center, Pittsfield, MA 01201 | 2014-10-03 |
| Street Address |
1055 DRESSER CT |
| City | RALEIGH |
| State | NC |
| Zip Code | 27609-7323 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538127964 | Sonia Renee Harris | Counselor | 1055 Dresser Ct, Raleigh, NC 27609-7323 | 2006-05-03 |
| 1326536467 | Lilach Yerushalmi-domb | Social Worker | 1055 Dresser Ct, Raleigh, NC 27609-7323 | 2018-04-24 |
| 1568959880 | Roberta Bellamy | Marriage & Family Therapist | 1055 Dresser Ct, Raleigh, NC 27609-7323 | 2018-04-23 |
| 1952802365 | Anne Marsland | Social Worker | 1055 Dresser Ct, Raleigh, NC 27609-7323 | 2018-02-22 |
| 1881127538 | Patrisha Campbell | Social Worker | 1055 Dresser Ct, Raleigh, NC 27609 | 2017-04-10 |
| 1790161263 | Kelly Crenshaw | Nurse Practitioner | 1055 Dresser Ct, Raleigh, NC 27609-7323 | 2015-08-06 |
| 1194120295 | Melanie Powell | Social Worker | 1055 Dresser Ct, Raleigh, NC 27609 | 2014-10-31 |
| 1255732707 | Jinzhao Ji | Physician Assistant | 1055 Dresser Ct, Raleigh, NC 27609-7323 | 2014-09-15 |
| 1861810715 | Carolina Partners In Mental | Non-Pharmacy Dispensing Site | 1055 Dresser Ct, Raleigh, NC 27609-7323 | 2014-03-28 |
| 1477976512 | Kristine Ashton | Physician Assistant | 1055 Dresser Ct, Raleigh, NC 27609-4244 | 2014-01-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184235582 | Choice Service Solutions LLC | In Home Supportive Care | 5300 Six Fox Rd Siite205, Raleigh, NC 27609 | 2020-08-11 |
| 1003426073 | Rosana Oba -rovira | Registered Nurse | 5300 Six Fox Road, Suite 205, Raleigh, NC 27609 | 2020-08-05 |
| 1821612706 | Helen Alexandra Bonner | Physical Medicine & Rehabilitation | Hey Clinic Pa, 3320 Wake Forest Road Ste 450, Raleigh, NC 27609 | 2020-06-05 |
| 1215423579 | Appiah Nana Larbi | Social Worker | Easter Seals Ucp 4000 Wake Forest Rd Ste 200, Raleigh, NC 27609 | 2018-07-10 |
| 1215423777 | Broadway Home Care LLC | In Home Supportive Care | 107 Windel Dr Ste 105, Raleigh, NC 27609 | 2018-07-09 |
| 1275027948 | Lacey Allene Cottingham | Social Worker | 312 W Millbrook Rd Ste 129, Raleigh, NC 27609 | 2018-06-18 |
| 1447748819 | Integrated Dermatology of North Raleigh, Pllc | Dermatology | 3809 Computer Dr Ste 200, Raleigh, NC 27609 | 2018-05-01 |
| 1902325418 | Naomi Christine Askew | Nurse Practitioner | 3400 Wake Forest Drive, Bldg 9, Bldg #9, 4th Floor, Raleigh, NC 27609 | 2017-09-15 |
| 1962929679 | Alexia Montague | Social Worker | 1306 Paddock Drive Suite E-100, Raleigh, NC 27609 | 2017-08-23 |
| 1730602236 | Chantel Washington-mbuthia | Counselor | 1100 Logger Ct. Ste C100, Heartfelt Alternative Inc, Raleigh, NC 27609 | 2017-07-18 |
| Find all providers in zip 27609 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376159400 | Ronald Jerome Patterson Jr. | Nurse Practitioner | 4204 Banks Stone Dr, Raleigh, NC 27603-4860 | 2020-09-23 |
| 1720490899 | Katherine Bilbro Fisher | Nurse Practitioner | 319 Chapanoke Rd Ste 120, Raleigh, NC 27603-3433 | 2014-05-23 |
| 1144651951 | Maria Agiato | Nurse Practitioner | 859 Washington St Ste A, Raleigh, NC 27605-3250 | 2013-12-04 |
| 1588091532 | Rejuvenated Minds, Pllc | Nurse Practitioner | 3719 Benson Drive, Raleigh, NC 27609-7324 | 2013-10-07 |
| 1598010803 | Linda Simpson Grimes | Nurse Practitioner | 3201 Edwards Mill Rd Ste 141, #163, Raleigh, NC 27612-5371 | 2012-07-24 |
| 1891040234 | Mary Anne Hughes | Nurse Practitioner | 8390 Six Forks Rd Ste 201, Raleigh, NC 27615-3060 | 2012-07-23 |
| 1447511779 | Rachell P Davis | Nurse Practitioner | 3719 Benson Dr, Suite 200, Raleigh, NC 27609-7324 | 2012-06-04 |
| 1992077788 | Ashley Hageman | Nurse Practitioner | 3012 Falstaff Rd, Raleigh, NC 27610 | 2012-02-08 |
| 1629372974 | Elizabeth Amos Corbett | Nurse Practitioner | 8801 Fast Park Dr Ste 107, Raleigh, NC 27617-4853 | 2010-12-30 |
| 1033386446 | Pamela Lynn Herbig Wall | Nurse Practitioner | 1130 Situs Ct, Ste 190, Raleigh, NC 27606-3391 | 2008-05-14 |
| Find all providers in RALEIGH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.