Wagoner Health Clinic, PLLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

WAGONER HEALTH CLINIC, PLLC

Practice address

1023 N Mound St Ste E
Nacogdoches, TX 75961-4453

Phone

(936) 305-4130

Fax

(936) 305-4127

NPI assigned

Nov 17, 2022

Organization subpart

No

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

Authorized official

Name

Mrs. Rebekah M Wagoner, APRN, FNP-CNPI 1770130437

Title

Managing Member

Phone

(936) 715-5353

Specialties & licenses 1

Addresses

Other names 1

• Wagoner Family Health Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rebekah Marie Wagoner, APRN, FNP-C

  • Family Nurse Practitioner
  • Nacogdoches, TX
  • NPI 1770130437
  Medicare reassignment Care Compare group NPD Authorized official
• James Lucas Wagoner, MSN, APRN, FNP-C

  • Family Nurse Practitioner
  • Nacogdoches, TX
  • NPI 1104470988
  Medicare reassignment Care Compare group NPD
• Luke Johnson, M.D., M.P.H.

  • Family Medicine Physician
  • Lufkin, TX
  • NPI 1457702623
  NPD (past)

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

{
    "created_epoch": "1668643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671408000000",
    "number": "1396454484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1023 N MOUND ST STE E",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759614453",
            "telephone_number": "936-305-4130",
            "fax_number": "936-305-4127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1023 N MOUND ST STE E",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759614453",
            "telephone_number": "936-305-4130",
            "fax_number": "936-305-4127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGONER HEALTH CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-17",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A",
        "authorized_official_last_name": "WAGONER",
        "authorized_official_first_name": "REBEKAH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "936-715-5353",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN, FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wagoner Family Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wagoner Family Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vip Hospice, LLC
• Kavita S Vyas, M.D.
• Shyam A Vyas, MD
• Kalisha Wade, CCC SLP
• Ladedra Wade
• James Lucas Wagoner, MSN, APRN, FNP-C
• Rebekah Marie Wagoner, APRN, FNP-C
• Cara Danielle Wagstaff, COTA
• Wal-Mart Stores Texas LLC
• Wal-Mart Stores Texas LLC

• Primary Care Nurse Practitioner in Nacogdoches, TX
• Providers in Nacogdoches, TX by specialty
• Primary Care Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.