Individual provider Active NPI

Scottie Walters, LPTN

  • Case Manager/Care Coordinator
  • Benton, AR
National Provider Identifier
1710264890
Registry record updated Jan 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
110 Pearson
Benton, AR 72015-4436
Phone
(501) 315-4224
Fax
(501) 778-0450
NPI assigned
Nov 3, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X T01708 AR
Case Manager/Care Coordinator 171M00000X Primary

Addresses

Primary practice location

110 Pearson
Benton, AR 72015-4436

Mailing address

110 Pearson
Benton, AR 72015-4436
Phone (501) 315-4224

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

LicenseStateTypeSpecialty
T01708ARMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1320278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675036800000",
    "number": "1710264890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 PEARSON",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720154436",
            "telephone_number": "501-315-4224",
            "fax_number": "501-778-0450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 PEARSON",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720154436",
            "telephone_number": "501-315-4224",
            "fax_number": "501-778-0450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "SCOTTIE",
        "credential": "LPTN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-03",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AR",
            "license": "T01708",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.