Stacey Alethea Waggoner, APRN-CNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

0083425 Issued in OK

Practice address

6613 N Meridian Ave
Oklahoma City, OK 73116-1423

Phone

(405) 603-8450

NPI assigned

Nov 13, 2015

Last updated

Jan 9, 2019By 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 2

Addresses

Other identifiers 1

Other names 1

• Stacey Alethea Waggoner Former name

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: waggones@yourcarecommunity.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Holloway Group Inc

  • Multi-Specialty Clinic/Center
  • Oklahoma City, OK
  • NPI 1497848147
  Medicare reassignment NPD

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

{
    "created_epoch": "1447372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546992000000",
    "number": "1285008227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6613 N MERIDIAN AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731161423",
            "telephone_number": "405-603-8450",
            "fax_number": "405-603-8454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6613 N MERIDIAN AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731161423",
            "telephone_number": "405-603-8450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "STACEY",
        "middle_name": "ALETHEA",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-13",
        "last_updated": "2019-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OK",
            "license": "0083425",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "83425",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200626780A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "WAGGONER",
            "middle_name": "ALETHEA",
            "credential": "APRN-CNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Theodore Lee Wagener, M.S.
• Cali Wages
• Brynna Helene Wagester
• David Bo Waggoner, D.C.
• Keri Waggoner, M.S CCC-SLP
• Brianna Wagner
• Dustin Wagner, PA
• Emily Wagner, PHARMD
• Heather Wagner
• Jack C Wagner

• Nurse Practitioner in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2019; 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.

Verify at the official NPI Registry.