WAL-MART STORES EAST, LP (NPI# 1174930150) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174930150 |
| Entity Type | Organization |
| Organization Name | WAL-MART STORES EAST, LP |
| Other Organization Name | WALMART CARE CLINIC 10-0658 |
| Practice Address |
2510 Redmond Cir Nw Rome GA 30165-1913 |
| Mailing Address |
702 Sw 8th St Bentonville AR 72716-0445 |
| Practice Telephone | 7067283246 |
| Practice Fax Number | 7062326598 |
| Mailing Telephone | 4792048550 |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2015-08-31 |
| Authorized Official Name | LAURA LEVINE (DIRECTOR OF HEALTHCARE CONTRACTING) |
| Authorized Official Telephone | 4792048550 |
| Is Organization Subpart | Y |
| Parent Organization Name | WAL-MART STORES, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | MEDICARE PTAN | 202G700075 | 01 |
| Other Name | Type Code |
|---|---|
| Walmart Care Clinic 10-0658 | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730798851 | Wal-mart Stores East, Lp | Technician/Technologist | 461 Rt 10 Suite A100, Ledgewood, NJ 07852 | 2020-07-24 |
| 1184156317 | Wal-mart Stores East, Lp | Durable Medical Equipment & Medical Supplies | 270 Heald Way, The Villages, FL 32163-6003 | 2017-03-28 |
| 1730611971 | Wal-mart Stores East, Lp | Durable Medical Equipment & Medical Supplies | 4401 Poole Rd., Raleigh, NC 27603-0000 | 2017-03-28 |
| 1720527955 | Wal-mart Stores East, Lp | Technician/Technologist | 2755 W Holton-whitehall Rd, Whitehall, MI 49461 | 2017-02-21 |
| 1003354580 | Wal-mart Stores East, Lp | Technician/Technologist | 2129 Grand Ave, Yazoo City, MS 39194 | 2017-02-06 |
| 1255874970 | Wal-mart Stores East, Lp | Technician/Technologist | 3410 Sw Market St, Lees Summit, MO 64082 | 2016-11-29 |
| 1538611066 | Wal-mart Stores East, Lp | Technician/Technologist | 546 First Colonial Road, Virginia Beach, VA 23451 | 2016-11-01 |
| 1760933196 | Wal-mart Stores East, Lp | Durable Medical Equipment & Medical Supplies | 1705 S Kings Hwy, Myrtle Beach, SC 29577-4601 | 2016-10-20 |
| 1700335312 | Wal-mart Stores East, Lp | Durable Medical Equipment & Medical Supplies | 3045 Sw Port St Lucie Blvd, Port St Lucie, FL 34953-0000 | 2016-09-23 |
| 1619425683 | Wal-mart Stores East, Lp | Technician/Technologist | 11930 Narcoossee Road, Orlando, FL 32832-0000 | 2016-09-19 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | WAL-MART STORES EAST, LP | 708 Sw 8th Street, Bentonville, AR 72716 |
| Massachusetts Corporations | WAL-MART STORES EAST, LP | 702 Sw 8th Street, Bentonville, AR 72716 |
| Oklahoma Business Registrations | WAL-MART STORES EAST, LP | 702 Sw 8th Street, Bentonville, AR 72716 |
| Oregon Corporations, Companies and Business Names | WAL-MART STORES EAST, LP, A LIMITED PARTNERSHIP OF DELAWARE | 708 Sw 8th Street, Bentonville, AR 72716 |
| Street Address |
2510 REDMOND CIR NW |
| City | ROME |
| State | GA |
| Zip Code | 30165-1913 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740207067 | Wal-mart Stores East Lp | Pharmacy | 2510 Redmond Cir Nw, Rome, GA 30165-1913 | 2006-07-16 |
| 1982204582 | Drashti Patel | Pharmacist | 2510 Redmond Cir Nw, Rome, GA 30165-1913 | 2020-11-01 |
| 1972103422 | John Small | Pharmacist | 2510 Redmond Cir Nw, Rome, GA 30165-1913 | 2020-10-26 |
| 1194127530 | Torrey Atchley | Nurse Practitioner | 2510 Redmond Cir Nw, Rome, GA 30165-1913 | 2014-09-17 |
| 1073602934 | Wal-mart Stores East, Lp | Technician/Technologist | 2510 Redmond Cir Nw, Rome, GA 30165-1913 | 2006-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346868775 | Heather Bowman | Physical Therapist | 600 Eagle, E Lake Dr, Rome, GA 30165 | 2020-07-13 |
| 1205451101 | Kristopher Nelson | Student in an Organized Health Care Education/Training Program | 4256, 304 Shorter Ave Nw #201, Rome, GA 30165 | 2020-06-16 |
| 1962061457 | Stuart Paul Shaklee | Occupational Therapy Assistant | 1356 Redmond Road, Rome, GA 30165 | 2019-06-10 |
| 1386001055 | Autumn Streetman | Counselor | 6 Mathis Drive, Rome, GA 30165 | 2016-01-26 |
| 1144695784 | Gabrador Milligan | Counselor | 6 Mathis Road, Rome, GA 30165 | 2015-12-08 |
| 1386041952 | Theresa Suits | Registered Nurse | 1 Woodbine Avenue, Rome, GA 30165 | 2014-11-26 |
| 1942561147 | Nicole C. Christian | Clinical Neuropsychologist | 305 Redmond Rd, Rome, GA 30165 | 2012-06-04 |
| 1679832711 | Niki Pareshkumar Bhavsar | Internal Medicine | 3041 Turner Mccall Blvd, Rome, GA 30165 | 2012-05-10 |
| 1285927491 | Amanda Fischer Reeves | Family Medicine | 304 Shorter Ave Nw Ste 102, Rome, GA 30165 | 2011-05-20 |
| 1033436647 | Northland Hearing Centers, Inc. | Hearing Instrument Specialist | 4 Coosawattee Ave, Rome, GA 30165 | 2010-04-23 |
| Find all providers in zip 30165 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043649817 | Satoya Loreen Hartfield | Nurse Practitioner | 330 Turner Mccall Blvd Sw Ste 107, Rome, GA 30165-5631 | 2013-11-02 |
| 1871773911 | Liza B Meltzer | Nurse Practitioner | 199 Reynolds Bend Dr Se, Rome, GA 30161-2539 | 2007-11-06 |
| 1285747493 | Karen Jenell Craig | Nurse Practitioner | 304 Turner Mccall Blvd, The Breast Center, Rome, GA 30165-0233 | 2006-08-15 |
| 1396769048 | Judy Norman Wilburn | Nurse Practitioner | Rome Cboc of The Syracuse Va, 125 Brookley Ave., Rome, NY 13441 | 2006-07-26 |
| 1851312680 | Tammy Michelle Hairel | Nurse Practitioner | 85 John Maddox Drive Connector Nw, Rome, GA 30165-1233 | 2006-07-21 |
| 1962440461 | Laurie Ansley Gerhard | Nurse Practitioner | 28 John Davenport Dr Nw, Rome, GA 30165-2536 | 2006-06-04 |
| 1194703181 | Lisa Pinkard Acree | Nurse Practitioner | 255 W 5th St Sw, Rome, GA 30165-2817 | 2006-01-09 |
| 1235110263 | Lori Ponder | Nurse Practitioner | 15 Riverbend Dr Sw, Ste 100, Rome, GA 30161-6065 | 2005-11-08 |
| 1689676041 | Karen Jean Roberts | Nurse Practitioner | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2005-08-15 |
| 1922605401 | Lauryn Goss Vines | Nurse Practitioner | 1825 Martha Berry Blvd Nw, Rome, GA 30165-1625 | 2020-10-07 |
| Find all providers in ROME | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.