Individual provider Active NPI

Jennifer Marie Myers, FNP-C

  • Nurse Practitioner
  • Forest City, NC
National Provider Identifier
1215311436
Registry record updated Apr 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5007790 Issued in NC
Practice address
112 Sparks Dr
Forest City, NC 28043-9021
Phone
(828) 651-6000
Fax
(828) 287-7436
NPI assigned
Jul 17, 2015
Last updated
Apr 28, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5007790 NC Primary
Family Nurse Practitioner 363LF0000X 5007790 NC

Addresses

Primary practice location

112 Sparks Dr
Forest City, NC 28043-9021

Mailing address

112 Sparks Dr
Forest City, NC 28043-9021
Phone (828) 651-6000

Other practice location 1

Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-4151

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, VA2 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

Enrollment IDStateProvider typePAC IDDetails
I20150921001654 NC Practitioner - Nurse Practitioner 2769799931 Reassigns benefits to 3 organizations
I20250623004050 VA Practitioner - Nurse Practitioner 2769799931 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
May accept Medicare assignment
Group practices
Wound Care SpecialistsGroup PAC ID 6608959549, 5 clinicians
Advanced Mobile Wound Care of Virginia LLCGroup PAC ID 8426573528, 11 clinicians
Old Mission Wound Care North Carolina, PLLCGroup PAC ID 0840723102, 2 clinicians

Practice addresses (Care Compare)

112 Sparks Dr
Forest City, NC 28043-9021
Phone (828) 351-6000

2109 India Rd
Charlottesville, VA 22901-2886
Phone (276) 685-1185

414 Fayetteville St
Raleigh, NC 27601-1793
Phone (231) 333-4388

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5007790NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Aug 17, 2015 Accepting new patients
Advanced Mobile Wound Care of Virginia LLC CurrentSince Dec 27, 2025 Accepting new patients
Old Mission Wound Care North Carolina, PLLC CurrentSince Aug 11, 2024 Accepting new patients
Scott Wagner Integrated Medicine LLC CurrentSince Jan 18, 2026 Accepting new patients

Locations

414 Fayetteville St
Raleigh, NC 27601
Phone (910) 627-2410

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

225 Matlage Way
Unit 31
Sugar Land, TX 77487

2109 India Rd
Charlottesvle, VA 22901
Phone (276) 685-1185

Organizations & group practices 6

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 5

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": "1437091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777334400000",
    "number": "1215311436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 SPARKS DR",
            "city": "FOREST CITY",
            "state": "NC",
            "postal_code": "280439021",
            "telephone_number": "828-651-6000",
            "fax_number": "828-287-7436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 SPARKS DR",
            "city": "FOREST CITY",
            "state": "NC",
            "postal_code": "280439021",
            "telephone_number": "828-651-6000",
            "fax_number": "828-287-7436"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Medical Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271570001",
            "country_code": "US",
            "telephone_number": "336-716-4151",
            "fax_number": "336-716-0524",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MYERS",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-17",
        "last_updated": "2026-04-28",
        "certification_date": "2026-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5007790",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5007790",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest City, NC

Sources for this page

Verify at the official NPI Registry.