Bethany Gale Wagener, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

APA2006 Issued in OK

Practice address

2901 N Classen Blvd
Suite 200
Oklahoma City, OK 73106-5493

Phone

(918) 594-1300

Fax

(918) 594-1312

NPI assigned

Mar 15, 2011

Last updated

Mar 15, 2011By 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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1300147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300147200000",
    "number": "1063711190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9014 W ROGERS BLVD",
            "city": "SKIATOOK",
            "state": "OK",
            "postal_code": "740705528",
            "telephone_number": "405-408-3547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 N CLASSEN BLVD",
            "address_2": "SUITE 200",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731065493",
            "telephone_number": "918-594-1300",
            "fax_number": "918-594-1312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENER",
        "first_name": "BETHANY",
        "middle_name": "GALE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-15",
        "last_updated": "2011-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "APA2006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandrea Fay Wadley, MMSC
• Edward F Wadley, PA
• Michael Anthony Wadley, D.D.S.
• Megan Rachelle Wadsack, LMSW
• Samantha J Wafer
• Theodore Lee Wagener, M.S.
• Cali Wages
• Brynna Helene Wagester
• David Bo Waggoner, D.C.
• Keri Waggoner, M.S CCC-SLP

• Physician Assistant in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2011; 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.