Lisa Marie Wade

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2015005062 Issued in MO

Practice address

1307 Porter Wagoner Blvd
West Plains, MO 65775-1828

Phone

(417) 255-8645

NPI assigned

Feb 20, 2015

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

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Ozarks Medical Center

  dba Ozarks Healthcare

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  Medicare reassignment

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

{
    "created_epoch": "1424390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1710379201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2811 GINGER DR",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657751571",
            "telephone_number": "417-293-2210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 PORTER WAGONER BLVD",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657751828",
            "telephone_number": "417-255-8645"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "805 N Kentucky Ave",
            "address_purpose": "LOCATION",
            "city": "West Plains",
            "state": "MO",
            "postal_code": "657752022",
            "country_code": "US",
            "telephone_number": "417-256-2111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WADE",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-20",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2015005062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AANP CERTIFICATION",
            "identifier": "F0215049",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Visionary Imaging LLC
• Vocational Visionary Opportunities
• Ashton Laine Vonallmen
• Crystal Voyles, LPN
• Johna Lee Wade, DC
• Tabatha Diane Wade
• Stefan Wadlow
• Ashli Wake
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0015)
• Wal-Mart Stores East, LP (Vision Center 30-0015)

• Family Nurse Practitioner in West Plains, MO
• Providers in West Plains, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.