Active NPI
Mackenna Luttrell, LMP
- Specialist
- Vancouver, WA
National Provider Identifier
1396153540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA60486817
- Practice address
- 13025 NE Fourth Plain Blvd
Suite 102
Vancouver, WA 98682 - Phone
- (360) 718-8240
- Fax
- (360) 718-8241
- NPI assigned
- Jul 31, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA60486817 | WA | Primary |
Addresses
Primary practice location
13025 NE Fourth Plain Blvd
Suite 102
Vancouver, WA 98682
Mailing address
956 14TH St
Washougal, WA 98671
Phone (360) 909-1173
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA60486817 | WA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| East Vancouver Chiropractic & Massage Therapy | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Chiropractor
- Vancouver, WA
- NPI 1982854592
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406764800000",
"number": "1396153540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "956 14TH ST",
"city": "WASHOUGAL",
"state": "WA",
"postal_code": "98671",
"telephone_number": "360-909-1173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13025 NE FOURTH PLAIN BLVD",
"address_2": "SUITE 102",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "98682",
"telephone_number": "360-718-8240",
"fax_number": "360-718-8241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUTTRELL",
"first_name": "MACKENNA",
"credential": "LMP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-07-31",
"last_updated": "2014-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA60486817",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.