Individual provider Active NPI

Jennifer Cherry Waggoner, CRNA

  • Certified Registered Nurse Anesthetist
  • Winston Salem, NC
National Provider Identifier
1669997201
Registry record updated Aug 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
5716 Issued in NC
Practice address
145 Kimel Park Dr Ste 120
Winston Salem, NC 27103-6983
Phone
(336) 768-3212
Fax
(336) 768-9019
NPI assigned
Aug 4, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 239951 NC
Certified Registered Nurse Anesthetist 367500000X 5716 NC Primary

Addresses

Primary practice location

145 Kimel Park Dr Ste 120
Winston Salem, NC 27103-6983

Mailing address

145 Kimel Park Dr Ste 120
Winston Salem, NC 27103-6983
Phone (336) 768-3212

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address JWAGGONER511270@DIRECT.NOVANTHEALTH.ORG

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171017003118 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 8123394236 Reassigns benefits to 14 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Moses H Cone Memorial Hospital Operating CorporationGroup PAC ID 6204744600, 724 clinicians
Medical Park Hospital LLCGroup PAC ID 4880595958, 109 clinicians
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

1200 N Elm St
Greensboro, NC 27401-1004
Phone (336) 832-7000

1200 N Elm St
Greensboro, NC 27401-1020

1950 S Hawthorne Rd
Winston Salem, NC 27103-3912
Phone (336) 718-0600

3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone (336) 718-5000

501 N Elam Ave
Greensboro, NC 27403-1118
Phone (336) 832-1000

509 E N Elam Ave
FL 3
Greensboro, NC 27403-1118
Phone (336) 832-1970

Hospital & facility affiliations

  • Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014
  • Moses H. Cone Memorial Hospital, the Hospital, Greensboro, NC, CCN 340091
  • Novant Health Medical Park Hospital Hospital, Winston-Salem, NC, CCN 340148

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
5716NCMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Triad Anesthesia, PA Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2017 Accepting new patients
Novant Health Kernersville Outpatient Surgery LLC Current Accepting new patients
Novant Health Rowan Medical Center, LLC CurrentSince Mar 1, 2020 Accepting new patients
Novant Health Rowan Medical Center LLC Nurse Anesthetist, Certified Registered Current Accepting new patients
The Presbyterian Hospital CurrentSince Aug 1, 2024 Accepting new patients
Forsyth Memorial Hospital, Inc. Current Accepting new patients
The Presbyterian Hospital Current Accepting new patients
Novant Health Clemmons Outpatient Surgery, LLC Current Accepting new patients
Rowan Regional Medical Center CurrentSince Mar 1, 2020 Accepting new patients
The Moses H. Cone Memorial Hospital Operating Corporation CurrentSince Feb 1, 2023 Accepting new patients
Presbyterian Sameday Surgery Center at Huntersville LLC Current Accepting new patients

Locations

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

7210 Village Medical Cir
Ste 235
Clemmons, NC 27012
Phone (336) 893-3100

509 N Elam Ave
Fl 3
Greensboro, NC 27403
Phone (336) 832-1970

1200 N Elm St
Greensboro, NC 27401
Phone (336) 574-7000

2400 W Friendly Ave
Greensboro, NC 27403
Phone (336) 832-1100

10030 Gilead Rd
Huntersville, NC 28078
Phone (704) 316-4000

1730 Kernersville Medical Pkwy
Ste 304
Kernersville, NC 27284
Phone (336) 515-7000

618 S Main St
Reidsville, NC 27320
Phone (336) 832-7965

612 Mocksville Ave
Salisbury, NC 28144
Phone (704) 210-5000

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

145 Kimel Park Dr
Ste 120
Winston Salem, NC 27103
Phone (336) 277-1770

1950 S Hawthorne Rd
Winston Salem, NC 27103
Phone (336) 718-0600

Interoperability endpoints

  • Direct secure messaging: jwaggoner511270@direct.novanthealth.org

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 3

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": "1501804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756080000000",
    "number": "1669997201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 KIMEL PARK DR STE 120",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036983",
            "telephone_number": "336-768-3212",
            "fax_number": "336-768-9019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 KIMEL PARK DR STE 120",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036983",
            "telephone_number": "336-768-3212",
            "fax_number": "336-768-9019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "JENNIFER",
        "middle_name": "CHERRY",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-04",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "239951",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "5716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JWAGGONER511270@DIRECT.NOVANTHEALTH.ORG",
            "affiliation": "N",
            "address_1": "145 Kimel Park Dr Ste 120",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271036983",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.