Active NPI
Kayleigh Wagner, LAT, ATC
- Sports Medicine (Preventive Medicine) Physician
- Erie, PA
National Provider Identifier
1316594674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Preventive Medicine) Physician
- License
- RT006112
- Practice address
- 501 W 12TH St
Erie, PA 16501-1536 - Phone
- (814) 455-3719
- NPI assigned
- Aug 21, 2019
- Last updated
- Aug 21, 2019
- 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 |
|---|---|---|---|---|
| Sports Medicine (Preventive Medicine) Physician | 2083S0010X | RT006112 | PA | Primary |
Addresses
Primary practice location
501 W 12TH St
Erie, PA 16501-1536
Mailing address
1443 Greenfield Dr
Erie, PA 16509-2912
Phone (814) 602-9206
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 |
|---|---|---|---|
| RT006112 | PA | MD | Sports Medicine (Preventive Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566345600000",
"number": "1316594674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1443 GREENFIELD DR",
"city": "ERIE",
"state": "PA",
"postal_code": "165092912",
"telephone_number": "814-602-9206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 W 12TH ST",
"city": "ERIE",
"state": "PA",
"postal_code": "165011536",
"telephone_number": "814-455-3719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "KAYLEIGH",
"credential": "LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-21",
"last_updated": "2019-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "2083S0010X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Sports Medicine",
"state": "PA",
"license": "RT006112",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.