Mallori Levengood

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

214790 Issued in AR

Practice address

2500 Rike Dr
Pine Bluff, AR 71603-3937

Phone

(870) 718-4428

NPI assigned

Feb 9, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AR, TX2 enrollments

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 2

Specialty

Nurse Practitioner

Education

University of Arkansas College of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Southeast Arkansas Behavioral Healthcare System IncGroup PAC ID 0042292674, 16 clinicians

Brightside Medical of Michigan PCGroup PAC ID 9830562776, 90 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Southeast Arkansas Behavioral Healthcare System Inc

  • Community/Behavioral Health Agency
  • Pine Bluff, AR
  • NPI 1457398547
  Medicare reassignment Care Compare group NPD
• Brightside Medical of Michigan PC

  • Psychiatry Physician
  • San Francisco, CA
  • NPI 1144800350

  AR

  Medicare reassignment Care Compare group NPD
• Brightside Medical, P.C.

  • Psychiatry Physician
  • San Francisco, CA
  • NPI 1801355482

  TX

  Medicare reassignment NPD
• Southeast Arkansas Behavioral Healthcare System

  • Community/Behavioral Health Agency
  • Star City, AR
  • NPI 1235384009
  NPD (past)
• Southeast Arkansas Behavioral Healthcare System Inc

  • Community/Behavioral Health Agency
  • Sheridan, AR
  • NPI 1770738734
  NPD (past)

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

{
    "created_epoch": "1612828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612828800000",
    "number": "1871185066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 RIKE DR",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716033937",
            "telephone_number": "870-718-4428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 RIKE DR",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716033937",
            "telephone_number": "870-718-4428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEVENGOOD",
        "first_name": "MALLORI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-09",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AR",
            "license": "214790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://sabhs.org",
            "affiliation": "N",
            "address_1": "2500 Rike Dr",
            "city": "Pine Bluff",
            "state": "AR",
            "country_code": "US",
            "postal_code": "716033937",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Florence Lee
• Monique Lee
• Amanda Christine Lem, APRN
• Stacy Leonard, MSPT
• Westy Dawn Leslie, PHARMD
• Andre L Lewis, L.C.S.W
• Johnetta Lewis
• Latasha Lewis
• Terry Liefde, MD
• Lighthouse Academies of Pine Bluff

• Psychiatric/Mental Health Nurse Practitioner in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.