Lisa Jane Wagoner, MHPP

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

316 Main St
Lake Village, AR 71653-1942

Phone

(870) 265-2186

Fax

(870) 265-2305

NPI assigned

May 7, 2012

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

Other names 1

• Lisa Jane Snow Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1336348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336348800000",
    "number": "1386903771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 MAIN ST",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "716531942",
            "telephone_number": "870-265-2186",
            "fax_number": "870-265-2305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 MAIN ST",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "716531942",
            "telephone_number": "870-265-2186",
            "fax_number": "870-265-2305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "LISA",
        "middle_name": "JANE",
        "credential": "MHPP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-07",
        "last_updated": "2012-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "SNOW",
            "middle_name": "JANE",
            "credential": "MHPP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Case Manager/Care Coordinator in Lake Village, AR
• Providers in Lake Village, AR by specialty
• Case Manager/Care Coordinator in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2012; 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.