1. Home
  2. Directory
  3. Arkansas
  4. Jonesboro
  5. Nurse Practitioner
  6. NPI Profile

TARA LISA WAGGONER FNP, APN-BC
NPI 1568515930
Nurse Practitioner - Family in Jonesboro, AR

Active since January 19, 2007PECOS Enrolled
333 STADIUM BLVD., SUITE B, JONESBORO, AR 72401(870) 972-2054 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Tara Lisa Waggoner Fnp, Apn-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TARA LISA WAGGONER FNP, APN-BC (NPI 1568515930) is an individual family provider in Jonesboro, Arkansas, licensed in Arkansas (A01852) and active in the NPI registry since January 2007. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1568515930
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameTARA LISA WAGGONERCredential: FNP, APN-BC
Location Address333 STADIUM BLVD., SUITE BJonesboro, AR 72401
Mailing Address4203 Sandstone DrJonesboro, AR 72401-7833 · (870) 910-0436
Phone(870) 972-2054
Sole ProprietorNo
Enumeration DateJanuary 19, 2007
Last NPPES UpdateJuly 8, 2007
✔ NPI 1568515930 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in AR · A01852
333 STADIUM BLVD., Jonesboro, AR 72401
Open in Google Maps ↗

Other Identifiers 1

Medicare UPINQ42646AR

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tara Lisa Waggoner Fnp, Apn-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

3

Medicare enrollment records show Tara Waggoner reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Northeast Arkansas Clinic Charitable Foundation, Inc
2.2 mi
Urgent Care
3001 APACHE DR STE B
Jonesboro, AR 72401
  • Reassigned Medicare billing, Arkansas enrollment
  • 439 clinicians in this Medicare group
NPI 1922789676 (870) 936-8000
Doctors Health Group, Inc
19 mi
Primary Care
4000 LINWOOD DRIVE, SUITE A
Paragould, AR 72450
  • Reassigned Medicare billing, Arkansas enrollment
  • 40 clinicians in this Medicare group
NPI 1700849692 (870) 239-8503
Signify Health Medical Associates, PLLC
404 mi
General Practice
4055 VALLEY VIEW LN STE 700
Dallas, TX 75244
  • Reassigned Medicare billing, Arkansas enrollment
  • 354 clinicians in this Medicare group
NPI 1750845863 (972) 715-3800

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 72401 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$79.72 typical visit price
range $51.36 – $157.74
Typical copayment $19.93 (range $12.84 – $39.43)
Most-billed visit code 99203
Established Patient
$91.63 typical visit price
range $16.16 – $128.77
Typical copayment $22.90 (range $4.04 – $32.19)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tara Waggoner's NPI number?

The NPI number for Tara Waggoner is 1568515930. It was assigned to this individual provider in the NPPES registry on January 19, 2007.

Where is Tara Waggoner located?

Tara Waggoner practices at 333 Stadium Blvd. Suite B, Jonesboro, AR 72401. The listed phone number is (870) 972-2054.

What is Tara Waggoner's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Tara Waggoner enrolled in Medicare?

Yes. Tara Waggoner is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Tara Waggoner's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Tara Waggoner reassigns Medicare benefits to 3 organizations: Northeast Arkansas Clinic Charitable Foundation, Inc (Jonesboro, AR), Doctors Health Group, Inc (Paragould, AR) and Signify Health Medical Associates, PLLC (Dallas, TX). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Tara Waggoner's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Tara Waggoner was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.