Wal-Mart Stores Texas, LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

WAL-MART STORES TEXAS, LLC

Practice address

4801 S Cooper St
Arlington, TX 76017-5928

Phone

(817) 557-8706

Fax

(817) 557-8740

NPI assigned

Jul 22, 2014

Last updated

Feb 19, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

WAL-MART STORES, INC.As reported in NPPES

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

Authorized official

Name

Laura Levine

Title

Director of Healthcare Contracting

Phone

(479) 204-8550

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Walmart Care Clinic 10-1801 Other name

Part of

Walmart Pharmacy 10-206

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

{
    "created_epoch": "1405987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424304000000",
    "number": "1619384690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445",
            "telephone_number": "479-204-8550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 S COOPER ST",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760175928",
            "telephone_number": "817-557-8706",
            "fax_number": "817-557-8740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES TEXAS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES, INC.",
        "enumeration_date": "2014-07-22",
        "last_updated": "2015-02-19",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "DIRECTOR OF HEALTHCARE CONTRACTING",
        "authorized_official_telephone_number": "479-204-8550"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "358654ZHTP",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Care Clinic 10-1801",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Nurse Practitioner in Arlington, TX
• Providers in Arlington, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2015; 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.