Active NPI
Scotty Wayne Russell, LMSW
- Clinical Social Worker
- Little Rock, AR
National Provider Identifier
1639391071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1783-M
- Practice address
- 4300 W 7TH St
Little Rock, AR 72205-5446 - Phone
- (501) 257-3316
- NPI assigned
- May 3, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1783-M | AR | Primary |
Addresses
Primary practice location
4300 W 7TH St
Little Rock, AR 72205-5446
Mailing address
1007 W Booth Rd
Searcy, AR 72143-8628
Phone (501) 279-7658
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1783-M | AR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639391071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1007 W BOOTH RD",
"city": "SEARCY",
"state": "AR",
"postal_code": "721438628",
"telephone_number": "501-279-7658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4300 W 7TH ST",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722055446",
"telephone_number": "501-257-3316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "SCOTTY",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AR",
"license": "1783-M",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.