Active NPI
Keshia Breanne Wagers, PH.D.
- Psychologist
- Manchester, KY
National Provider Identifier
1104496504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 56 Marie Langdon Dr
Manchester, KY 40962-6329 - Phone
- (606) 598-4539
- NPI assigned
- Jun 28, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
56 Marie Langdon Dr
Manchester, KY 40962-6329
Mailing address
56 Marie Langdon Dr
Manchester, KY 40962-6329
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital, Inc. | Multi-Specialty | Current | Accepting new patients |
| Memorial Hospital, Inc. | Multi-Specialty | Current | Accepting new patients |
| Memorial Hospital, Inc. | Multi-Specialty | Current | Accepting new patients |
| Memorial Hospital, Inc. | Current | Accepting new patients |
Locations
102 Professional Dr
#2
London, KY 40741
Phone (606) 598-4500
1033 N Highway 11
Manchester, KY 40962
Phone (606) 598-6163
210 Marie Langdon Dr
Manchester, KY 40962
Phone (865) 985-7047
53 Queendale Ctr
Red Bird, KY 40913
Phone (606) 598-5135
Interoperability endpoints
- kwagers694527@adventhealth.direct-ci.com
Organizations & group practices 5
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Rural Health Clinic/Center
- Manchester, KY
- NPI 1255471827
-
- Multi-Specialty Clinic/Center
- Manchester, KY
- NPI 1033510961
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633478400000",
"number": "1104496504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "56 MARIE LANGDON DR",
"city": "MANCHESTER",
"state": "KY",
"postal_code": "409626329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "56 MARIE LANGDON DR",
"city": "MANCHESTER",
"state": "KY",
"postal_code": "409626329",
"telephone_number": "606-598-4539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGERS",
"first_name": "KESHIA",
"middle_name": "BREANNE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-06-28",
"last_updated": "2021-10-06",
"certification_date": "2021-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manchester, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; 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.