Julie Lydolph, MD

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

221590 Issued in AR

Practice address

2200 Malcolm Ave
Newport, AR 72112-3668

Phone

(870) 512-2500

Fax

(870) 512-2525

NPI assigned

Sep 20, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Nurse Practitioner

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

{
    "created_epoch": "1663632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1306569991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2197",
            "city": "BATESVILLE",
            "state": "AR",
            "postal_code": "725032197",
            "telephone_number": "870-262-5545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 MALCOLM AVE",
            "city": "NEWPORT",
            "state": "AR",
            "postal_code": "721123668",
            "telephone_number": "870-512-2500",
            "fax_number": "870-512-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYDOLPH",
        "first_name": "JULIE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-20",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "221590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerrod O Lockhart, LMSW
• Devesha Lott, RECOVERY ASSISTANT
• Frank Love Jr., O.D.
• LTC of Newport, LLC
• Dennis W Luter, M.D.
• Lateljia Mallory-Bonaparte
• Mary Mansker
• Jasmine Mansko, MS, CCC-SLP
• Patricia M Mason
• Maxus Inc

• Family Nurse Practitioner in Newport, AR
• Providers in Newport, AR by specialty
• Family Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; 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.