Wal-Mart Stores Texas, LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

WAL-MART STORES TEXAS, LLC

Practice address

1213 E Trinity Mills Rd
Carrollton, TX 75006-1446

Phone

(469) 557-7390

Fax

(972) 242-4124

NPI assigned

Jun 2, 2014

Organization subpart

Yes

Parent organization

WAL-MART STORES, INC.As reported in NPPES

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

Authorized official

Name

Laura Levine

Title

Director of Healthcare Contracting

Phone

(479) 204-8550

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Walmart Care Clinic 10-1216 Other name

Part of

Walmart Pharmact

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

{
    "created_epoch": "1401667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424304000000",
    "number": "1275945891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445",
            "telephone_number": "479-204-8550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 E TRINITY MILLS RD",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750061446",
            "telephone_number": "469-557-7390",
            "fax_number": "972-242-4124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES TEXAS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES, INC.",
        "enumeration_date": "2014-06-02",
        "last_updated": "2015-02-19",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "DIRECTOR OF HEALTHCARE CONTRACTING",
        "authorized_official_telephone_number": "479-204-8550"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "358652ZHTN",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Care Clinic 10-1216",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sanketkumar Vyas
• Deborah Lee Wade, PHD
• Wal-Mart Stores Texas LLC
• Wal-Mart Stores Texas LLC
• Wal-Mart Stores Texas LLC
• Wal-Mart Stores Texas, LP
• Nikki Anderson Walden, M.D.
• Walgreen Co
• Walgreen Co
• Walgreen Co

• Nurse Practitioner in Carrollton, TX
• Providers in Carrollton, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.