Shelby Young Wager, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DT83604 Issued in TX

Practice address

619 S Fleishel Ave
Ste 327
Tyler, TX 75701-2004

Phone

(903) 510-1173

Fax

(903) 525-1312

NPI assigned

Mar 26, 2015

Last updated

Dec 28, 2015By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1427328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451260800000",
    "number": "1205220373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 846098",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752846098",
            "telephone_number": "903-324-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 S FLEISHEL AVE",
            "address_2": "STE 327",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012004",
            "telephone_number": "903-510-1173",
            "fax_number": "903-525-1312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGER",
        "first_name": "SHELBY",
        "middle_name": "YOUNG",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-26",
        "last_updated": "2015-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT83604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• April Denise Waddel
• Latoyia M Wade
• Marcus L Wade, LMSW/LCDC
• Tiffany Renae' Wade, NP-C
• Roy Brent Wadle, D.O.
• Rebecca S Waggoner, NP
• Brittany Wagner, MD
• Gina L Wagner, PT
• Kelsey Wagner
• Demeshia Wagoner

• Registered Dietitian in Tyler, TX
• Providers in Tyler, TX by specialty
• Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2015; 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.