Individual provider Active NPI

Christine Carol Wellman

  • Psychiatric/Mental Health Nurse Practitioner
  • Little Rock, AR
National Provider Identifier
1922575042
Registry record updated Oct 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
A005893 Issued in AR
Practice address
11321 Interstate 30 Ste 304
Little Rock, AR 72209-7067
Phone
(501) 487-6010
Fax
(501) 202-7513
NPI assigned
Oct 26, 2018
Last updated
Oct 26, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X A005893 AR Primary

Addresses

Primary practice location

11321 Interstate 30 Ste 304
Little Rock, AR 72209-7067

Mailing address

11321 Interstate 30 Ste 304
Little Rock, AR 72209-7067
Phone (501) 478-6010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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

Enrollment IDStateProvider typePAC IDDetails
I20190129001063 AR Practitioner - Nurse Practitioner 4880931823 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arkansas Health GroupGroup PAC ID 7911802079, 645 clinicians

Practice addresses (Care Compare)

11321 Interstate 30
Suite 304
Little Rock, AR 72209-7067
Phone (501) 487-6010

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A005893ARMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Arkansas Health Group Psychiatric/Mental Health CurrentSince Dec 9, 2018 Accepting new patients
Arkansas Health Group CurrentSince Dec 9, 2018 Accepting new patients
Arkansas Health Group Past Accepting new patients

Locations

11001 Executive Center Dr
Ste 200
Little Rock, AR 72211
Phone (501) 812-7215

11321 Interstate 30
Ste 304
Little Rock, AR 72209
Phone (501) 455-9500

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1540512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540512000000",
    "number": "1922575042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11321 INTERSTATE 30 STE 304",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722097067",
            "telephone_number": "501-478-6010",
            "fax_number": "501-202-7513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11321 INTERSTATE 30 STE 304",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722097067",
            "telephone_number": "501-487-6010",
            "fax_number": "501-202-7513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLMAN",
        "first_name": "CHRISTINE",
        "middle_name": "CAROL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-26",
        "last_updated": "2018-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AR",
            "license": "A005893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.