Active NPI
Kiara Nicole Wagoner, LMHC
- Mental Health Counselor
- Indianapolis, IN
National Provider Identifier
1295926723
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 39002180A
- Practice address
- 1500 North Ritter Avenue
Indianapolis, IN 46219-3027 - Phone
- (317) 355-2560
- Fax
- (317) 355-2418
- NPI assigned
- Aug 8, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 39002180A | IN | Primary |
Addresses
Primary practice location
1500 North Ritter Avenue
Indianapolis, IN 46219-3027
Mailing address
1500 N Ritter Ave
Indianapolis, IN 46219-3027
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100270530 | Medicaid | IN |
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 |
|---|---|---|---|
| 39002180A | IN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412208000000",
"number": "1295926723",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 N RITTER AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462193027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 NORTH RITTER AVENUE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462193027",
"telephone_number": "317-355-2560",
"fax_number": "317-355-2418"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGONER",
"first_name": "KIARA",
"middle_name": "NICOLE",
"credential": "LMHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-08",
"last_updated": "2014-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IN",
"license": "39002180A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100270530",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.