Individual provider Active NPI

Tao Wang, NP

  • Family Nurse Practitioner
  • Magnolia, AR
National Provider Identifier
1275177073
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A006185 Issued in AR
Practice address
100 E University
Magnolia, AR 71753-2181
Phone
(870) 235-5255
NPI assigned
Nov 5, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A006185 AR Primary

Addresses

Primary practice location

100 E University
Magnolia, AR 71753-2181

Mailing address

811 Olive
Magnolia, AR 71753-3020
Phone (870) 345-0250

Other practice location 1

1920 Galleria Oaks Dr
Texarkana, TX 75503-4619
Phone (903) 792-6114

Other identifiers 1

IdentifierTypeStateIssuer
A006185OtherARARKANSAS STATE BOARD OF NURSING

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address twang@saumag.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AR2 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
I20240718004957 TX Practitioner - Nurse Practitioner 8628514239 Reassigns benefits to 1 organization
I20250217000154 AR Practitioner - Nurse Practitioner 8628514239 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Venvisor Health of Ar PAGroup PAC ID 8022551647, 55 clinicians

Practice addresses (Care Compare)

1202 NE McClain Rd
BLDG 7
Bentonville, AR 72712-3875
Phone (203) 901-2493

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince Aug 19, 2024 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Aug 19, 2024 Accepting new patients
Venvisor Health of Ar PA CurrentSince Jan 1, 2025 Accepting new patients
Pallicare, Inc CurrentSince Dec 3, 2025 Accepting new patients

Locations

1202 NE McClain Rd
Bentonville, AR 72712
Phone (479) 278-4323

1920 Galleria Oaks Dr
Texarkana, TX 75503
Phone (903) 792-6114

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1572912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1275177073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 OLIVE",
            "city": "MAGNOLIA",
            "state": "AR",
            "postal_code": "717533020",
            "telephone_number": "870-345-0250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E UNIVERSITY",
            "city": "MAGNOLIA",
            "state": "AR",
            "postal_code": "717532181",
            "telephone_number": "870-235-5255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1920 Galleria Oaks Dr",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755034619",
            "country_code": "US",
            "telephone_number": "903-792-6114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "TAO",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-05",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A006185",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS STATE BOARD OF NURSING",
            "identifier": "A006185",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "twang@saumag.edu",
            "affiliation": "N",
            "address_1": "100 E University",
            "city": "Magnolia",
            "state": "AR",
            "country_code": "US",
            "postal_code": "717532181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Magnolia, AR

Sources for this page

Verify at the official NPI Registry.