LAKE WALES DERMATOLOGY
NPI 1962088138
Dermatology in Lake Wales, FL

Active since March 19, 2021
134 E TILLMAN AVE, LAKE WALES, FL 33853(863) 269-0790 Get Directions Write a Review

NPPES record last updated: April 14, 2021. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Apr 14, 2021, Mar 19, 2021 (2 updates tracked since 2021).

About Lake Wales Dermatology NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE WALES DERMATOLOGY (NPI 1962088138) is a healthcare organization registered as a dermatology in Lake Wales, Florida and active in the NPI registry since March 2021. The organization maintains a secondary practice location in Lake Wales and lists Raymond Knisley, Owner, as its authorized official.

NPPES Registry Identity

NPI1962088138
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameDISTINCTIVE DERMATOLOGY PLLC
Location Address134 E TILLMAN AVELake Wales, FL 33853-4130
Mailing Address134 E Tillman AveLake Wales, FL 33853-4130 · (863) 269-0790
Organization SubpartNo
Authorized OfficialRaymond KnisleyOwner · (863) 269-0790
Enumeration DateMarch 19, 2021
Last NPPES UpdateApril 14, 20212 updates tracked since enumeration
NPPES CertifiedApril 14, 2021
NPI 1962088138 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
134 E TILLMAN AVE, Lake Wales, FL 33853

Other Names 1

Doing Business AsLake Wales Dermatology

Secondary Practice Location 1

Location 11255 State Road 60 E Ste 100Lake Wales, FL 33853-4310 · Phone (863) 269-0790

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Distinctive Dermatology PLLC's NPI number?

The NPI number for Distinctive Dermatology PLLC is 1962088138. It was assigned to this organization in the NPPES registry on March 19, 2021. The provider is doing business as Lake Wales Dermatology.

Where is Distinctive Dermatology PLLC located?

Distinctive Dermatology PLLC is located at 134 E Tillman Ave, Lake Wales, FL 33853. The listed phone number is (863) 269-0790.

What is Distinctive Dermatology PLLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

When was this NPI record last updated?

The NPPES record for Distinctive Dermatology PLLC was last updated on April 14, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.