Donnelle I. Wagner, DNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

ATP000123 Issued in AR

Practice address

4620 Rogers Ave
Fort Smith, AR 72903-3149

Phone

(479) 384-5380

Fax

(479) 384-5382

NPI assigned

Jan 2, 2008

Last updated

Sep 13, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Northwest Arkansas Ambulatory Services, LLCGroup PAC ID 3779827993, 50 clinicians

River Valley Primary Care ServicesGroup PAC ID 0042274276, 39 clinicians

Mercy Clinic Fort Smith CommunitiesGroup PAC ID 3870668510, 361 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Mercy Northwest Arkansas Ambulatory Services LLC

  • Urgent Care Clinic/Center
  • Springdale, AR
  • NPI 1366922320
  Medicare reassignment Care Compare group NPD
• River Valley Primary Care Services

  • Federally Qualified Health Center (FQHC)
  • Ratcliff, AR
  • NPI 1952349003
  Medicare reassignment Care Compare group NPD
• Mercy Clinic Fort Smith Communities

  • Multi-Specialty Clinic/Center
  • Fort Smith, AR
  • NPI 1902073620
  Medicare reassignment Care Compare group
• River Valley Primary Care Services

  dba Mountainburg Community Pharmacy

  • Community/Retail Pharmacy
  • Mountainburg, AR
  • NPI 1164222113
  NPD
• River Valley Primary Care Services

  dba Mountainburg Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Mountainburg, AR
  • NPI 1639302896
  NPD
• River Valley Primary Care Services

  dba Clarksville Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Clarksville, AR
  • NPI 1205322542
  NPD (past)
• River Valley Primary Care Services

  dba Northside Clinic at 6th Street

  • Federally Qualified Health Center (FQHC)
  • Fort Smith, AR
  • NPI 1568647519
  NPD (past)
• River Valley Primary Care Services

  dba Lamar School District Health Center

  • Federally Qualified Health Center (FQHC)
  • Lamar, AR
  • NPI 1699010991
  NPD (past)
• River Valley Primary Care Services

  dba Waldron Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Waldron, AR
  • NPI 1992212013
  NPD (past)
• WH Ar Medical PLLC

  dba Walmart Health Virtual Care

  • Family Medicine Physician
  • Springdale, AR
  • NPI 1235861147
  NPD (past)
• Wound Solutions of Central Arkansas LLC

  • Clinic/Center
  • Jonesboro, AR
  • NPI 1447952346
  NPD (past)

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

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1225213812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4620 ROGERS AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729033149",
            "telephone_number": "479-384-5380",
            "fax_number": "479-384-5382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4620 ROGERS AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729033149",
            "telephone_number": "479-384-5380",
            "fax_number": "479-384-5382"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3700 Cliff Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Smith",
            "state": "AR",
            "postal_code": "729035954",
            "country_code": "US",
            "telephone_number": "479-709-7260",
            "fax_number": "479-709-7261",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "DONNELLE",
        "middle_name": "I.",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-02",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "ATP000123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168334758",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200130940A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Waddell, LPTA
• Wyatt Waddell, PTA
• Josh Wade, PTA
• Moorea Wade, QBHP
• Lindsey Rene Waessil, RN
• Micaiah Wagner, DPT
• Shane L Wagner, MHPP
• Andrea Waguespack
• Lauren Paige Wahlmeier, PA-C
• Gerald Eugene Wahman, M.D.

• Family Nurse Practitioner in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Family Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.