Individual provider Active NPI

Becky Lynn Witham, FNP-C

  • Family Nurse Practitioner
  • Rolla, MO
National Provider Identifier
1386047025
Registry record updated Apr 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2014035055 Issued in MO
Practice address
1060 W 10TH St
Rolla, MO 65401-2905
Phone
(855) 406-3324
Fax
(573) 458-8363
NPI assigned
Oct 8, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2014035055 MO Primary

Addresses

Primary practice location

1060 W 10TH St
Rolla, MO 65401-2905

Mailing address

1050 W 10TH St
Rolla, MO 65401-2905
Phone (855) 406-3324

Other practice location 1

1000 W 10th St
Rolla, MO 65401-2905
Phone (573) 364-9000

Other practice location 2

1000 W 10th St
Rolla, MO 65401-2905
Phone (573) 458-8899

Other identifiers 1

IdentifierTypeStateIssuer
1386047025MedicaidMO

Other names 1

  • Becky Lynn Smith Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141211000542 MO Practitioner - Nurse Practitioner 5799007225 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pcrmc Medical Group IncGroup PAC ID 1557454063, 113 clinicians

Practice addresses (Care Compare)

1050 W 10TH St
Rolla, MO 65401-2905
Phone (573) 364-9000

1060 W 10TH St
Rolla, MO 65401-2905
Phone (855) 406-3324

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pcrmc Medical Group, Inc CurrentSince Jan 1, 2017 Accepting new patients
Phelps County Regional Medical Center CurrentSince Dec 16, 2023 Accepting new patients
Phelps County Regional Medical Center CurrentSince Jan 1, 2017 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1422 S Sam Houston Blvd
Houston, MO 65483
Phone (417) 967-1252

1050 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

1050 W 10th St
Ofc
Rolla, MO 65401
Phone (573) 458-3740

1060 W 10th St
Rolla, MO 65401
Phone (855) 406-3324

600 Blues Lake Pkwy
Rolla, MO 65401
Phone (573) 364-5719

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1412726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1386047025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "855-406-3324",
            "fax_number": "573-458-8363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 W 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "855-406-3324",
            "fax_number": "573-458-8363"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654012905",
            "country_code": "US",
            "telephone_number": "573-364-9000",
            "fax_number": "573-426-2108",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654012905",
            "country_code": "US",
            "telephone_number": "573-458-8899",
            "fax_number": "573-341-5611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WITHAM",
        "first_name": "BECKY",
        "middle_name": "LYNN",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-08",
        "last_updated": "2025-04-18",
        "certification_date": "2025-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2014035055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386047025",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BECKY",
            "last_name": "SMITH",
            "middle_name": "LYNN",
            "credential": "FNP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rolla, MO

Sources for this page

Verify at the official NPI Registry.