Shelby Lynn Van Wagoner, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5019198 Issued in NC

Practice address

811 Spring Forest Rd Ste 1400
Raleigh, NC 27609-9145

Phone

(919) 999-6793

NPI assigned

Nov 27, 2023

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 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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1701043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1730955162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 SPRING FOREST RD STE 1400",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276099145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 SPRING FOREST RD STE 1400",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276099145",
            "telephone_number": "919-999-6793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN WAGONER",
        "first_name": "SHELBY",
        "middle_name": "LYNN",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-27",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5019198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Van Products, Inc.
• Sarah Van Putten
• Meredith Van Rensburg, LCMHC
• Christian Van Schaik, PT
• Tracy L Van Steen
• Matthew Ryan Van, PSY.D.
• Jagriti Vanam, DDS
• Jill C Vanarthos, PA
• William James Vanarthos, M.D.
• Joana Hermina Vanboven, PA-S

• Family Nurse Practitioner in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.