Active NPI
D'Ovionn Wagner, LAT, ATC
- Athletic Trainer
- Tucson, AZ
National Provider Identifier
1124892377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- ATR-009586
- Practice address
- 1625 N Campbell Ave Ste 8423
Tucson, AZ 85719-4330 - Phone
- (928) 286-7136
- NPI assigned
- Nov 8, 2023
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | ATR-009586 | AZ | Primary |
Addresses
Primary practice location
1625 N Campbell Ave Ste 8423
Tucson, AZ 85719-4330
Mailing address
PO Box 1402
Fort Defiance, AZ 86504-1402
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ATR-009586 | AZ | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1699401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701820800000",
"number": "1124892377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1402",
"city": "FORT DEFIANCE",
"state": "AZ",
"postal_code": "865041402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1625 N CAMPBELL AVE STE 8423",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857194330",
"telephone_number": "928-286-7136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "D'OVIONN",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-11-08",
"last_updated": "2023-12-06",
"certification_date": "2023-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AZ",
"license": "ATR-009586",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.