Lydia Waller, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

R027919 Issued in AR

Practice address

10618 Breckenridge Dr
Little Rock, AR 72211-1802

Phone

(501) 217-8600

Fax

(501) 217-8636

NPI assigned

Aug 22, 2014

Sex

Female

Sole proprietor

No

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)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1408665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408665600000",
    "number": "1386043651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10618 BRECKENRIDGE DR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722111802",
            "telephone_number": "501-217-8600",
            "fax_number": "501-217-8636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10618 BRECKENRIDGE DR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722111802",
            "telephone_number": "501-217-8600",
            "fax_number": "501-217-8636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "LYDIA",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-22",
        "last_updated": "2014-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AR",
            "license": "R027919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Witherspoon Wallace, MD
• Tiffany Wallace, PLMSW
• Ceon Evonne Waller
• Emily Katherine Waller, MD
• Larry Henle Waller, M.D.
• Jesse Walley
• Jenelle Wallis, APRN
• Pamela Ann Wallis, CCC/SLP
• Valerie Ann Wallis, CRNA
• Brooke Contois Walls, PA-C

• Registered Nurse in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Registered Nurse in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2014; 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.