OrganizationActive
Distinctive Dermatology PLLC
NPI 1962088138 · Dermatology Physician · Lake Wales, FL
Provider details
- NPI number
- 1962088138
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Raymond Knisley, Owner(863) 269-0790
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(67/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
134 E Tillman Ave
Lake Wales, FL 33853-4130
Phone: (863) 269-0790
Street-level locationGet directions
Mailing address
134 E Tillman Ave
Lake Wales, FL 33853-4130
Other names (DBA / former)
- Doing business as
- Lake Wales Dermatology
Additional practice locations (1)
- 1255 State Road 60 E Ste 100Lake Wales, FL 33853-4310Phone: (863) 269-0790
Registry dates
- Enumerated
- 2021-03-19
- Last updated
- 2021-04-14
- Certified
- 2021-04-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.