Krista Waggoner, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA16585 Issued in FL

Practice address

4875 Palm Coast Pkwy NW Unit 2
Palm Coast, FL 32137-3671

Phone

(386) 446-9935

Fax

(386) 446-7777

NPI assigned

Jun 22, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Kind Pediatric Therapy

  • Speech-Language Pathologist
  • Lavon, TX
  • NPI 1306599477
  NPD Authorized official

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

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645401600000",
    "number": "1346760170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 BRAVES WAY",
            "city": "LAVON",
            "state": "TX",
            "postal_code": "751664700",
            "telephone_number": "734-620-4533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4875 PALM COAST PKWY NW UNIT 2",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321373671",
            "telephone_number": "386-446-9935",
            "fax_number": "386-446-7777"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112 Braves Way",
            "address_purpose": "LOCATION",
            "city": "Lavon",
            "state": "TX",
            "postal_code": "751664700",
            "country_code": "US",
            "telephone_number": "734-620-4533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "KRISTA",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-22",
        "last_updated": "2022-02-21",
        "certification_date": "2022-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "117777",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA16585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA HEALTHCARE PRACTIONER LICENSE",
            "identifier": "SA16585",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA HEALTHCARE PRACTIONER LICENSE",
            "identifier": "SZ8087",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS SPEECH-LANGUAGE PATHOLOGIST LICENSE",
            "identifier": "117777",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carol Ann Volante, A.R.N.P
• Evan Volpert
• Ashley Taylor Voyles, PA-C
• Janae' L. Wadley
• Justin Wage, M.D.
• George W Waite, O.D.
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Brittney Alise Walden, APRN, FNP-BC
• Walgreen Co

• Speech-Language Pathologist in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2022; 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.