Jennifer M Wagner

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

APRN.CNP.0042761 Issued in OH

Practice address

2400 Miami Valley Dr
Centerville, OH 45459-4774

Phone

(937) 208-8394

Fax

(937) 641-2780

NPI assigned

Jul 20, 2026

Last updated

Aug 11, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1784505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786406400000",
    "number": "1003736984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3170 KETTERING BLVD BLDG B2ND",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 MIAMI VALLEY DR",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594774",
            "telephone_number": "937-208-8394",
            "fax_number": "937-641-2780"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9000 N Main St",
            "address_purpose": "LOCATION",
            "city": "Englewood",
            "state": "OH",
            "postal_code": "454151180",
            "country_code": "US",
            "telephone_number": "937-208-8394",
            "fax_number": "937-641-2780",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Middletown",
            "state": "OH",
            "postal_code": "450052584",
            "country_code": "US",
            "telephone_number": "513-974-2111",
            "fax_number": "513-974-5156",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3130 N County Road 25A",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "OH",
            "postal_code": "453731337",
            "country_code": "US",
            "telephone_number": "937-440-4466",
            "fax_number": "937-440-4470",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Wyoming St Ste Se3100B",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454092722",
            "country_code": "US",
            "telephone_number": "937-208-8394",
            "fax_number": "937-641-2780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-07-20",
        "last_updated": "2026-08-11",
        "certification_date": "2026-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OH",
            "license": "APRN.CNP.0042761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mangala Venkatesh, M.D.
• Jeffrey T Vercher, PA C
• Elizabeth Virgin
• Virtus Ohio Pharmacy, LLC (Centerville LTC Pharmacy)
• Keith Anthony Vukasinovich, LPCC
• Michelle Lee Wagner, RPH
• Jay Owen Wainscott, LPCC, LICDC-CS
• Jilian Waite, M.D.
• Wal-Mart Stores East LP (Walmart Pharmacy 10-1503)
• Walgreen Co (Walgreens #07636)

• Acute Care Nurse Practitioner in Centerville, OH
• Providers in Centerville, OH by specialty
• Acute Care Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.