Individual provider Active NPI

Laurie A Stone, FNP

  • Family Nurse Practitioner
  • Johnson City, TN
National Provider Identifier
1285954404
Registry record updated Jan 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN22148 Issued in TN
Practice address
917 W Walnut St
Johnson City, TN 37604
Phone
(423) 439-6464
Fax
(423) 439-7118
NPI assigned
Jun 10, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024168827 VA
Family Nurse Practitioner 363LF0000X APN22148 TN Primary

Addresses

Primary practice location

917 W Walnut St
Johnson City, TN 37604

Mailing address

PO Box 699
Mountain Home, TN 37684-0699
Phone (423) 433-6039

Other identifiers 2

IdentifierTypeStateIssuer
Q037397MedicaidTN
1528155892OtherCVFP CORPORATE NPI

Other names 1

  • Laurie A Wagoner Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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

Enrollment IDStateProvider typePAC IDDetails
I20181213000982 TN Practitioner - Nurse Practitioner 1658568647 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

917 W Walnut St
Johnson City, TN 37604-6527
Phone (423) 439-6464

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0024168827VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Education Assistance Corporation CurrentSince Jul 7, 2018 Accepting new patients

Locations

400 E State of Franklin Rd
Johnson City, TN 37601
Phone (423) 433-6200

917 W Walnut St
Johnson City, TN 37604
Phone (423) 439-6464

Organizations & group practices 1

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 4

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": "1276128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1285954404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "MOUNTAIN HOME",
            "state": "TN",
            "postal_code": "376840699",
            "telephone_number": "423-433-6039",
            "fax_number": "423-433-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 W WALNUT ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37604",
            "telephone_number": "423-439-6464",
            "fax_number": "423-439-7118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STONE",
        "first_name": "LAURIE",
        "middle_name": "A",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-10",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024168827",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APN22148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q037397",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CVFP CORPORATE NPI",
            "identifier": "1528155892",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURIE",
            "last_name": "WAGONER",
            "middle_name": "A",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.