Individual provider Active NPI

Tracy Lynn Wyngaard, APNP

  • Nurse Practitioner
  • Yadkinville, NC
National Provider Identifier
1659825123
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5011861 Issued in NC
Practice address
305 E Lee Ave
Yadkinville, NC 27055-8132
Phone
(336) 679-2661
Fax
(336) 679-7056
NPI assigned
Aug 12, 2016
Last updated
Sep 4, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 7132 WI
Nurse Practitioner 363L00000X 5011861 NC Primary

Addresses

Primary practice location

305 E Lee Ave
Yadkinville, NC 27055-8132

Mailing address

PO Box 751803
Charlotte, NC 28275-1803

Other practice location 1

50 Miller St Ste C
Winston Salem, NC 27104-4206
Phone (336) 310-5535

Other practice location 2

2452 Fairlawn Ct
Winston Salem, NC 27106-3884
Phone (336) 443-9910

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address twyngaard717503@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20190923003519 NC Practitioner - Nurse Practitioner 0446545750 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

305 E Lee Ave
Yadkinville, NC 27055-8132
Phone (336) 679-2661

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5011861NCMDNurse Practitioner
7132WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Forsyth Memorial Hospital, Inc. CurrentSince Aug 8, 2024 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Aug 8, 2024 Accepting new patients
Forsyth Memorial Hospital, Inc Past Accepting new patients
Prohealth Medical Group Inc Past Accepting new patients

Locations

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

291 Broad St
Kernersville, NC 27284
Phone (336) 993-8181

100 Robinhood Medical Plz
Winston Salem, NC 27106
Phone (336) 718-0560

305 E Lee Ave
Yadkinville, NC 27055
Phone (336) 679-2661

Interoperability endpoints

  • Direct secure messaging: twyngaard717503@direct.novanthealth.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1470960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1659825123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 E LEE AVE",
            "city": "YADKINVILLE",
            "state": "NC",
            "postal_code": "270558132",
            "telephone_number": "336-679-2661",
            "fax_number": "336-679-7056"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50 Miller St Ste C",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271044206",
            "country_code": "US",
            "telephone_number": "336-310-5535",
            "fax_number": "336-310-1183",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2452 Fairlawn Ct",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271063884",
            "country_code": "US",
            "telephone_number": "336-443-9910",
            "fax_number": "336-443-9909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYNGAARD",
        "first_name": "TRACY",
        "middle_name": "LYNN",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-12",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "7132",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5011861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "twyngaard717503@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "50 Miller St Ste C",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271044206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Yadkinville, NC

Sources for this page

Verify at the official NPI Registry.