Tara Lisa Waggoner, FNP, APN-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

A01852 Issued in AR

Practice address

333 Stadium Blvd.
Suite B
Jonesboro, AR 72401

Phone

(870) 972-2054

NPI assigned

Jan 19, 2007

Last updated

Jul 8, 2007By 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

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

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.

• Doctors Health Group, Inc

  dba Paragould Doctors' Clinic

  • Primary Care Clinic/Center
  • Paragould, AR
  • NPI 1700849692
  Medicare reassignment NPD
• Northeast Arkansas Clinic Charitable Foundation, Inc.

  dba NEA Baptist Clinic

  • Multi-Specialty Clinic/Center
  • Jonesboro, AR
  • NPI 1861721839
  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  AR

  Medicare reassignment NPD
• Doctors Health Group, Inc

  dba Piggott Family Medical Clinic

  • Family Medicine Physician
  • Piggott, AR
  • NPI 1649061201
  NPD
• Northeast Arkansas Clinic Charitable Foundation, Inc.

  dba NEA Baptist Mobile Health Unit

  • Mobile Mammography Clinic/Center
  • Jonesboro, AR
  • NPI 1417721689
  NPD
• Northeast Arkansas Clinic, PA

  dba NEA Clinic

  • Multi-Specialty Clinic/Center
  • Jonesboro, AR
  • NPI 1376517177
  NPD (past)

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1568515930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4203 SANDSTONE DR",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724017833",
            "telephone_number": "870-910-0436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 STADIUM BLVD.",
            "address_2": "SUITE B",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "72401",
            "telephone_number": "870-972-2054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "TARA",
        "middle_name": "LISA",
        "credential": "FNP, APN-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A01852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rashele Wade
• Sandra N Wade, PHARM.D
• Allison Sue Wadkins, MHPP
• Valerie Wadlington, MHW
• Tina Wages
• Devon Taylor Wagner, QBHP
• Holland Victoria Wagner, LCSW
• Jim A Wagner, DDS, MS
• Ruthie Wagner
• Wake Up Satisfied PA

• Family Nurse Practitioner in Jonesboro, AR
• Providers in Jonesboro, 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 Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.