NPIMap

Individual provider Active NPI

Mary Knuth Tucker, F.N.P.

  • Family Nurse Practitioner
  • North Wilkesboro, NC
National Provider Identifier
1942299789
Registry record updated Dec 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
200814 Issued in NC
Practice address
1405 Willow LN
Suite a
North Wilkesboro, NC 28659-3551
Phone
(336) 667-0335
Fax
(336) 667-4434
NPI assigned
Oct 14, 2005
Last updated
Dec 11, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2013

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 200814 NC Primary

Addresses

Primary practice location

1405 Willow LN
Suite a
North Wilkesboro, NC 28659-3551

Mailing address

1405 Willow LN
Suite a
North Wilkesboro, NC 28659-3551
Phone (336) 667-0335

Other identifiers 3

IdentifierTypeStateIssuer
0481610001OtherSCDMERC/PGBA
0575OtherNCMEDICARE GROUP
8902938MedicaidNC

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
I20090427000074 NC Practitioner - Nurse Practitioner 1254489594 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

111 Riddle Rd
North Wilkesboro, NC 28659-8890
Phone (336) 921-1362

1915 W Park Dr
North Wilkesboro, NC 28659-3777

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
200814NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Jul 1, 2017 Accepting new patients
Wilkes Physician Network, Inc. Current Accepting new patients

Locations

1405 Willow Ln
Ste A
North Wilkesboro, NC 28659
Phone (336) 667-0335

1916 W Park Dr
North Wilkesboro, NC 28659
Phone (336) 839-9563

200 W Park Cir
Ste C
North Wilkesboro, NC 28659
Phone (336) 568-7700

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

Interoperability endpoints

  • Direct secure messaging: mtucker2753441@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 2

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 6

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": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386720000000",
    "number": "1942299789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 WILLOW LN",
            "address_2": "SUITE A",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286593551",
            "telephone_number": "336-667-0335",
            "fax_number": "336-667-4434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 WILLOW LN",
            "address_2": "SUITE A",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286593551",
            "telephone_number": "336-667-0335",
            "fax_number": "336-667-4434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "MARY",
        "middle_name": "KNUTH",
        "credential": "F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-14",
        "last_updated": "2013-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "200814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC/PGBA",
            "identifier": "0481610001",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "0575",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8902938",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Wilkesboro, NC

Sources for this page

Verify at the official NPI Registry.