Courtney Lee Wagner, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN5178468 Issued in FL

Practice address

6261 Old Bethel Rd
Crestview, FL 32536-5507

Phone

(850) 683-7500

Fax

(850) 683-7523

NPI assigned

Oct 25, 2007

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1193270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193270400000",
    "number": "1295914331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 HOSPITAL DR NE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325485066",
            "telephone_number": "850-833-9240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6261 OLD BETHEL RD",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325365507",
            "telephone_number": "850-683-7500",
            "fax_number": "850-683-7523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "COURTNEY",
        "middle_name": "LEE",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-25",
        "last_updated": "2007-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "PN5178468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn M Vlass, PT
• Carolyn C Volz, O.T.
• Sarah Vongunten
• W. Michelle Long, LCSW, Professional Limited Liability Company
• Ashley C Wagner, PA
• William Scott Wakefield, MD
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Sheryl Smith Walker

• Licensed Practical Nurse in Crestview, FL
• Providers in Crestview, FL by specialty
• Licensed Practical Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; 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.