Ashley Christine Wagner

Primary specialty

Sports Medicine (Preventive Medicine) PhysicianTaxonomy code 2083S0010X

License

AT5055 Issued in TX

Practice address

3724 Executive Center Dr Ste G10
Austin, TX 78731-1665

Phone

(512) 324-9720

NPI assigned

Feb 18, 2019

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: ashley.wagner.2@8363.direct.athenahealth.com

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

{
    "created_epoch": "1550448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550448000000",
    "number": "1104382936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "428 LEWISVILLE LN",
            "city": "LEANDER",
            "state": "TX",
            "postal_code": "786414046",
            "telephone_number": "361-500-2803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3724 EXECUTIVE CENTER DR STE G10",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787311665",
            "telephone_number": "512-324-9720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ASHLEY",
        "middle_name": "CHRISTINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-18",
        "last_updated": "2019-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083S0010X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Sports Medicine",
            "state": "TX",
            "license": "AT5055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF TEXAS LICENSURE",
            "identifier": "AT5055",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF CERTIFICATION",
            "identifier": "2000007383",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer L. Wade, LCSW
• Alyssa Renee Wadley, HIS
• Alexis Waetzig, PT, DPT
• Brooke Ruth Wagen, MD
• Emily Anne Waggoner
• Brandi Marie Wagner
• Christina Wagner, LMFT
• David Robert Wagner, D.C.
• Elizabeth Marie Wagner
• Jennifer Wagner, LCSW

• Sports Medicine (Preventive Medicine) Physician in Austin, TX
• Providers in Austin, TX by specialty
• Sports Medicine (Preventive Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2019; 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.