Individual provider Active NPI

Lanay Amberly Fonda, FNP-C

  • Family Nurse Practitioner
  • Roanoke, VA
National Provider Identifier
1366900482
Registry record updated Oct 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024177477 Issued in VA
Practice address
1111 S Jefferson St Ste B
Roanoke, VA 24016-4724
Phone
(540) 769-3964
NPI assigned
Mar 7, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 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 0024177477 VA Primary

Addresses

Primary practice location

1111 S Jefferson St Ste B
Roanoke, VA 24016-4724

Mailing address

PO Box 8310
Roanoke, VA 24014-0310
Phone (540) 345-3556

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20200204000115 VA Practitioner - Nurse Practitioner 6103250873 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wiggington Road Family Practice IncGroup PAC ID 3870559396, 4 clinicians

Practice addresses (Care Compare)

113 Wiggington Rd
Suite a
Lynchburg, VA 24502-5189
Phone (434) 385-7578

Hospital & facility affiliations

  • Centra Health - Lynchburg Gen Hospital Hospital, Lynchburg, VA, CCN 490021

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wiggington Road Family Practice Inc CurrentSince Nov 1, 2024 Accepting new patients

Locations

113 Wiggington Rd
Lynchburg, VA 24502
Phone (434) 385-7578

113 Wiggington Rd
Ste A
Lynchburg, VA 24502
Phone (434) 385-7578

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 7

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": "1551916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1366900482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8310",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240140310",
            "telephone_number": "540-345-3556",
            "fax_number": "540-566-3889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 S JEFFERSON ST STE B",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164724",
            "telephone_number": "540-769-3964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONDA",
        "first_name": "LANAY",
        "middle_name": "AMBERLY",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-07",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024177477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.