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Individual

DR. CRYSTAL LYNNE TILLMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DNP, CPNP, PMHNP-BC

Contact information

Practice address
1055 DRESSER CT, RALEIGH, NC 27609-7323
(919) 876-3130
Mailing address
830 BRYAN ST, RALEIGH, NC 27605-1104
(704) 906-1428

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
300186
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
300186
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
300186
NURSING AND MEDICAL BOARD PRESCRIBING NUMBER
NC
Enumeration date
12/28/2012
Last updated
10/28/2015
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