Stephen James Waggoner, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P15783 Issued in NC

Practice address

190 Kimel Park Dr Ste 139
Winston Salem, NC 27103-6946

Phone

(336) 718-6931

Fax

(336) 718-3389

NPI assigned

Mar 10, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1615334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623801600000",
    "number": "1043895261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601791",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601791",
            "telephone_number": "336-718-6931",
            "fax_number": "336-718-3389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 KIMEL PARK DR STE 139",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036946",
            "telephone_number": "336-718-6931",
            "fax_number": "336-718-3389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "STEPHEN",
        "middle_name": "JAMES",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-10",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P15783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "swaggoner876836@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "190 Kimel Park Dr Ste 139",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271036946",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stephen B Wade, MD
• Rozina Nizar Wadhwania, MD
• Karen Emily Wadman, RNC,CNNP
• Kimberly Anne Waggener, MD
• Jennifer Cherry Waggoner, CRNA
• Kim A Wagner-Evans, MS, LPC-A, LCAS-A
• April Diane Wagner
• Gwendolyn Field Wagoner, M.D.
• Jennifer Kay Wagstaff
• Ali Saeed Wahla, M.D

• Physical Therapist in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.