NPIMap

Individual provider Active NPI

Phyllis Thornton Waggoner, NP-C

  • Family Nurse Practitioner
  • Mechanicsville, VA
National Provider Identifier
1831542190
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024173765 Issued in VA
Practice address
8015 Cold Harbor Rd
Mechanicsville, VA 23111-1650
Phone
(800) 640-3451
NPI assigned
Jul 21, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024173765 VA Primary

Addresses

Primary practice location

8015 Cold Harbor Rd
Mechanicsville, VA 23111-1650

Mailing address

PO Box 1200
Pleasant Grove, UT 84062-1200
Phone (800) 640-3451

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20161003000375 VA Practitioner - Nurse Practitioner 5395032536 Reassigns benefits to 5 organizations
I20161021000118 DC Practitioner - Nurse Practitioner 5395032536 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
May accept Medicare assignment
Group practices
Advanced Mobile Wound Care of Virginia LLCGroup PAC ID 8426573528, 11 clinicians
Plaid Eagle Medical PLLCGroup PAC ID 6103268560, 35 clinicians

Practice addresses (Care Compare)

2109 India Rd
Charlottesville, VA 22901-2886
Phone (276) 685-1185

8015 Cold Harbor Rd
Mechanicsville, VA 23111-1650
Phone (800) 640-3451

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0024173765VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Family Practice Associates of Chesterfield PC CurrentSince Oct 1, 2022 Accepting new patients
Plaid Eagle Medical PLLC CurrentSince Jul 1, 2025 Accepting new patients
Minuteclinic Diagnostic of Virginia LLC Family CurrentSince Aug 15, 2016 Accepting new patients

Locations

1636 Belle View Blvd
Alexandria, VA 22307
Phone (703) 703-7687

11271 Nuckols Rd
Glen Allen, VA 23059
Phone (804) 217-8881

19305 Ruby Dr
Leesburg, VA 20176
Phone (571) 333-5918

8015 Cold Harbor Rd
Mechanicsvlle, VA 23111

7048 Mechanicsville Tpke
Mechanicsvlle, VA 23111
Phone (804) 357-4763

13911 St Francis Blvd
#101
Midlothian, VA 23114
Phone (804) 320-3999

Organizations & group practices 5

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 11

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": "1469059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750723200000",
    "number": "1831542190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1200",
            "city": "PLEASANT GROVE",
            "state": "UT",
            "postal_code": "840621200",
            "telephone_number": "800-640-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8015 COLD HARBOR RD",
            "city": "MECHANICSVILLE",
            "state": "VA",
            "postal_code": "231111650",
            "telephone_number": "800-640-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "PHYLLIS",
        "middle_name": "THORNTON",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-21",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024173765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mechanicsville, VA

Sources for this page

Verify at the official NPI Registry.