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General NPI Number Information
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NPI Number | 1235951070
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Entity Type | Individual
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Provider Name | RICHARD AUSTIN LEWALLEN II PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 01/04/2026
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Provider Practice Location Address
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Address Line | 15811 AMBAUM BLVD SW STE 110
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City | BURIEN
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State | WA
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Zip | 98166-3071
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Country | US
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Telephone | 206-647-0070
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Fax | 206-629-6470
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Provider Business Mailing Address
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Address Line | 100 N HOWARD ST STE R
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City | SPOKANE
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State | WA
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Zip | 99201-0508
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Country | US
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Telephone | 206-647-0070
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Fax | 206-629-6470
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 331689
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | GAA-NP002848
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61629938
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License Number State | WA
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