Judith G Lewallen, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

A03622 Issued in AR

Practice address

100 Jessie James Blvd
Pineville, MO 64856

Phone

(417) 223-7050

Fax

(417) 223-7055

NPI assigned

Jul 22, 2005

Last updated

Oct 26, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Judith G Keeton Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Elk River Health Services, Inc.

  dba Pineville Medical Clinic

  • Rural Health Clinic/Center
  • Pineville, MO
  • NPI 1548269046
  NPD (past)
• Elk River Health Services, Inc.

  dba Pineville Medical Clinic

  • Family Medicine Physician
  • Pineville, MO
  • NPI 1851420525
  NPD (past)

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351209600000",
    "number": "1093715740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 JESSIE JAMES BLVD",
            "city": "PINEVILLE",
            "state": "MO",
            "postal_code": "64856",
            "telephone_number": "417-223-7050",
            "fax_number": "417-223-7055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 JESSIE JAMES BLVD",
            "city": "PINEVILLE",
            "state": "MO",
            "postal_code": "64856",
            "telephone_number": "417-223-7050",
            "fax_number": "417-223-7055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWALLEN",
        "first_name": "JUDITH",
        "middle_name": "G",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-22",
        "last_updated": "2012-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AK",
            "license": "1028",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "085477",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A03622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUDITH",
            "last_name": "KEETON",
            "middle_name": "G",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gary D. Neymeyer, O.D., P.C.
• Heart and Vascular Care
• Kylie Marie Helm
• Megan Nicole Knox, D.C.
• Diane Marie Kunkel, LPC/NCC
• Lifestyle Wellness Center LLC
• Lifestyle Wellness Center, LLC
• Kayla Nicole Loving
• Rachael Gabriela McCann, PHARMD
• Gilbert R Morgan, D.C.

• Family Nurse Practitioner in Pineville, MO
• Providers in Pineville, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.