Individual provider Active NPI

Tristan McKenna, FNP-C

  • Nurse Practitioner
  • Wilmington, NC
National Provider Identifier
1912354739
Registry record updated May 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5008581 Issued in NC
Practice address
1415 Physicians Dr
Wilmington, NC 28401-7338
Phone
(910) 662-9500
Fax
(910) 662-9501
NPI assigned
May 23, 2016
Last updated
May 27, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 260336 NC
Nurse Practitioner 363L00000X 5008581 NC Primary

Addresses

Primary practice location

1415 Physicians Dr
Wilmington, NC 28401-7338

Mailing address

PO Box 936857
Atlanta, GA 31193-6857

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tmckenna75742@direct.nhrmc.org Direct

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
I20160803002457 NC Practitioner - Nurse Practitioner 3274507801 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2131 S 17TH St
Wilmington, NC 28401-7407
Phone (910) 667-7000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
260336NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health New Hanover Regional Medical Center LLC CurrentSince Feb 1, 2021 Accepting new patients
NMG Health Services LLC CurrentSince May 1, 2021 Accepting new patients
Novant Health Medical Group Coastal Region, LLC Current Accepting new patients
Novant Health New Hanover Regional Medical Center LLC Current Accepting new patients
Novant Health Medical Group Coastal Region, LLC CurrentSince May 1, 2021 Accepting new patients
Novant Health New Hanover Regional Medical Center LLC CurrentSince Feb 1, 2021 Accepting new patients
New Hanover Medical Group PA Past Accepting new patients

Locations

584 Hospital Dr NE
Unit E
Bolivia, NC 28422
Phone (910) 754-5453

507 E Fremont St
Burgaw, NC 28425
Phone (910) 259-5451

800 Jefferson St
Ste 112
Whiteville, NC 28472
Phone (910) 642-8164

1415 Physicians Dr
Wilmington, NC 28401
Phone (910) 251-3766

1725 New Hanover Medical Park Dr
Wilmington, NC 28403
Phone (910) 662-9300

1726 New Hanover Medical Park Dr
Wilmington, NC 28403
Phone (910) 662-9384

2131 S 17th St
Wilmington, NC 28401
Phone (910) 342-3000

2221 S 17th St
Wilmington, NC 28401
Phone (910) 662-7720

Interoperability endpoints

  • Direct secure messaging: tmckenna1249210@direct.novanthealth.org
  • Direct secure messaging: tmckenna75742@direct.nhrmc.org

Organizations & group practices 7

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": "1463961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622073600000",
    "number": "1912354739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936857",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311936857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 PHYSICIANS DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017338",
            "telephone_number": "910-662-9500",
            "fax_number": "910-662-9501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENNA",
        "first_name": "TRISTAN",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-23",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "260336",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5008581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmckenna75742@direct.nhrmc.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "2131 S 17th St",
            "city": "Wilmington",
            "state": "NC",
            "country_code": "US",
            "postal_code": "284017407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.