Active NPI
Mary Lauderdale
- Behavior Technician
- Lowell, AR
National Provider Identifier
1861149239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-22-203007
- Practice address
- 212 S Lincoln St
Lowell, AR 72745-9782 - Phone
- (479) 770-0744
- NPI assigned
- Mar 7, 2022
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-22-203007 | AR | Primary |
Addresses
Primary practice location
212 S Lincoln St
Lowell, AR 72745-9782
Mailing address
PO Drawer 2109
Russellville, AR 72811
Phone (479) 967-2322
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 273474706 | Medicaid | AR |
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
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-22-203007 | AR | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673222400000",
"number": "1861149239",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "212 S LINCOLN ST",
"city": "LOWELL",
"state": "AR",
"postal_code": "727459782",
"telephone_number": "479-770-0744"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAUDERDALE",
"first_name": "MARY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-07",
"last_updated": "2023-01-09",
"certification_date": "2023-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "AR",
"license": "RBT-22-203007",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "273474706",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lowell, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.