Tracy Shari Wollenberg, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

53-76420 Issued in KS

Practice address

650 Huebner Rd
Fort Riley, KS 66442-4030

Phone

(785) 240-7652

NPI assigned

Jul 9, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1404864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521763200000",
    "number": "1730595976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 HUEBNER RD",
            "city": "FORT RILEY",
            "state": "KS",
            "postal_code": "664424030",
            "telephone_number": "785-240-7652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 HUEBNER RD",
            "city": "FORT RILEY",
            "state": "KS",
            "postal_code": "664424030",
            "telephone_number": "785-240-7652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLLENBERG",
        "first_name": "TRACY",
        "middle_name": "SHARI",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-09",
        "last_updated": "2018-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "KS",
            "license": "53-76420",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KS",
            "license": "53-76420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201120250A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Wilson Windom III, DDS
• James Winstead, PA
• Kelly Jean Winter, DO
• Aaron Michael Wold, MD
• Axel Wolff, D.P.T.
• Karen Arleen Woods, LMSW-C/M
• Jessica Anne Wright, RN BSN
• Benjaman Wunderlich, MS, RD, LD, CSSD
• Benjamin Salazar Yabut Jr., M.D.
• Lauren Yancy, PHARM.D.

• Nurse Practitioner in Fort Riley, KS
• Providers in Fort Riley, KS by specialty
• Nurse Practitioner in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.