NPIMap

Individual provider Active NPI

Tyrone Jermaine Walcott, NP

  • Nurse Practitioner
  • Rancho Cucamonga, CA
National Provider Identifier
1942199526
Registry record updated Apr 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5022573 Issued in CA
Practice address
10801 6TH St Ste 120
Rancho Cucamonga, CA 91730-5987
Phone
(800) 440-4347
NPI assigned
Jun 30, 2025
Sex
Unspecified or another gender identity
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 5022573 NC
Nurse Practitioner 363L00000X 5022573 CA Primary

Addresses

Primary practice location

10801 6TH St Ste 120
Rancho Cucamonga, CA 91730-5987

Mailing address

4195 Chino Hills Pkwy
Chino Hills, CA 91709-2618
Phone (910) 323-1718

Other practice location 1

4195 Chino Hills Pkwy
Chino Hills, CA 91709-2618
Phone (732) 322-0213

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251001003878 NC Practitioner - Nurse Practitioner 9436655149 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cape Fear Valley Health Medical Group LLCGroup PAC ID 0648707109, 352 clinicians

Practice addresses (Care Compare)

6201 Raeford Rd
Fayetteville, NC 28304-2425
Phone (910) 609-3780

Hospital & facility affiliations

  • Cape Fear Valley Medical Center Hospital, Fayetteville, NC, CCN 340028

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5022573CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cape Fear Valley Health Medical Group LLC CurrentSince Aug 11, 2025 Accepting new patients
Cape Fear Valley Health Medical Group LLC Current Accepting new patients
Cape Fear Valley Health Medical Group LLC CurrentSince Aug 11, 2025 Accepting new patients

Locations

4140 Ferncreek Dr
Ste 801
Fayetteville, NC 28314
Phone (910) 484-2171

6201 Raeford Rd
Fayetteville, NC 28304
Phone (910) 486-7777

1307 Avon St
Fayetteville, NC 28304
Phone (910) 323-1718

Interoperability endpoints

  • Direct secure messaging: twalcott131706@capefearvalley.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1751241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776988800000",
    "number": "1942199526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4195 CHINO HILLS PKWY",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917092618",
            "telephone_number": "910-323-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10801 6TH ST STE 120",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917305987",
            "telephone_number": "800-440-4347"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4195 Chino Hills Pkwy",
            "address_purpose": "LOCATION",
            "city": "Chino Hills",
            "state": "CA",
            "postal_code": "917092618",
            "country_code": "US",
            "telephone_number": "732-322-0213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALCOTT",
        "first_name": "TYRONE",
        "middle_name": "JERMAINE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2025-06-30",
        "last_updated": "2026-04-24",
        "certification_date": "2026-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NC",
            "license": "5022573",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "5022573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

Verify at the official NPI Registry.