Mayra Lara

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

1200 S Elmira Ave
Russellville, AR 72802-9646

Phone

(479) 968-7118

Fax

(479) 968-8628

NPI assigned

Aug 10, 2021

Last updated

Jan 13, 2023By the provider in NPPES

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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

• Friendship Community Care Inc.

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Russellville, AR
  • NPI 1528144318
  NPD

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

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673568000000",
    "number": "1700551009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO DRAWER 2109",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "72811",
            "telephone_number": "479-967-2322",
            "fax_number": "479-967-2876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S ELMIRA AVE",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728029646",
            "telephone_number": "479-968-7118",
            "fax_number": "479-968-8628"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "212 S Lincoln St Ste A",
            "address_purpose": "LOCATION",
            "city": "Lowell",
            "state": "AR",
            "postal_code": "727459722",
            "country_code": "US",
            "telephone_number": "479-770-0744",
            "fax_number": "479-770-0176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARA",
        "first_name": "MAYRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-10",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273474706",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lance Lawrence DDS PA
• Summer Nicole Land, PTA
• Lane Physical Therapy Center, Inc
• Cameron A Lane, DPT
• Victoria Jayne Langford, AG-ACNP
• Kay G Larsen, LMT
• Barbara J Larue
• Leslie Lawhorn
• Frank M Lawrence, M.D.
• Lance Anthony Lawrence, D.D.S.

• Behavior Technician in Russellville, AR
• Providers in Russellville, AR by specialty
• Behavior Technician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; 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.