Katelyn Shelby Wagner, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFT.0002519 Issued in CO

Practice address

802 Graydon Ave Apt A2
Norfolk, VA 23507-1532

Phone

(602) 568-2038

NPI assigned

Feb 13, 2024

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 4, 2024 through Apr 4, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1707782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1326802992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 BALCONES DR STE 100",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787314298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 GRAYDON AVE APT A2",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071532",
            "telephone_number": "602-568-2038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KATELYN",
        "middle_name": "SHELBY",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-13",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "204276",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CO",
            "license": "MFT.0002519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy L. Waddell, RDH
• Wagner Kapoor Research Institute LLC
• Alan Lewis Wagner, MD
• Heidi Wagner, C.P.O.
• John Wagner, MD
• Maxwell Solomon Wagner, MD
• Todd L Wagner, D.O., M.P.H.
• Melissa Waide, CPNP
• Lance Waite
• Rozlyn Wakefield, CRNA

• Marriage & Family Therapist in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Marriage & Family Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.