Cheryl Anne Wagner, ARNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

227591 Issued in AZ

Practice address

7600 E Florentine Rd
Prescott Valley, AZ 86314-1295

Phone

(928) 772-1610

NPI assigned

Sep 23, 2013

Last updated

Apr 17, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in AZ

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

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Group practices

Southwest Behavioral Health Services IncGroup PAC ID 9739075854, 49 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Southwest Behavioral Health Services Inc

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1144384389
  Medicare reassignment Care Compare group NPD
• Southwest Behavioral Health Services, Inc.

  • Psychiatric Residential Treatment Facility
  • Kingman, AZ
  • NPI 1023556339
  NPD

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

{
    "created_epoch": "1379894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1023444049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 N 3RD ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122331",
            "telephone_number": "602-351-6986",
            "fax_number": "602-265-8533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 E FLORENTINE RD",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863141295",
            "telephone_number": "928-772-1610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "CHERYL",
        "middle_name": "ANNE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-23",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "227591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vital Healthcare Az LLC
• Vitalab Pharmacy Inc (Vasco Infusion)
• Vitas Laboratory LLC
• Kelly Gerrit Vredeveld, PT, DPT
• Michael Vu, M.D.
• Wal-Mart Stores, Inc
• Michelle Rene Walblay, M.ED.
• Walgreen Co (Walgreens #06666)
• Christopher Walker, RPH
• Kimberly S. Wallach, P.A.-C

• Psychiatric/Mental Health Nurse Practitioner in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.