NPI Code Detail JSON Logo

1235951070 NPI number — RICHARD AUSTIN LEWALLEN II PMHNP-BC

NPI Number: 1235951070
Health Care Provider/Practitioner: RICHARD AUSTIN LEWALLEN II PMHNP-BC

Information about “1235951070” NPI (RICHARD AUSTIN LEWALLEN II PMHNP-BC) exists in 1235951070 in HTML format HTML  |  1235951070 in plain Text format TXT  |  1235951070 in PDF (Portable Document Format) PDF  |  1235951070 in an XML format XML  formats.

NPI Number : 1235951070 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1235951070",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LEWALLEN",
    "FirstName": "RICHARD",
    "MiddleName": "AUSTIN",
    "NamePrefix": "MR.",
    "NameSuffix": "II",
    "Credential": "PMHNP-BC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "100 N HOWARD ST STE R",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SPOKANE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "99201-0508",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "206-647-0070",
    "MailingAddressFaxNumber": "206-629-6470",
    "FirstLinePracticeLocationAddress": "15811 AMBAUM BLVD SW STE 110",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BURIEN",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98166-3071",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "206-647-0070",
    "PracticeLocationAddressFaxNumber": "206-629-6470",
    "EnumerationDate": "10/31/2024",
    "LastUpdateDate": "01/04/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "331689",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "GAA-NP002848",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "AP61629938",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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