Destiny Wagoner

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

2300 Foothill Blvd
Rock Springs, WY 82901-5610

Phone

(307) 352-6677

NPI assigned

Jun 7, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654560000000",
    "number": "1396474136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 FOOTHILL BLVD",
            "city": "ROCK SPRINGS",
            "state": "WY",
            "postal_code": "829015610",
            "telephone_number": "307-352-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 FOOTHILL BLVD",
            "city": "ROCK SPRINGS",
            "state": "WY",
            "postal_code": "829015610",
            "telephone_number": "307-352-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "DESTINY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-07",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassandra Renee Vincelette, BS
• Jeremy Vincent, LPC
• Rebekah Vondenkamp
• Rikki S Vondenkamp
• Courtney Dawn Wagner
• Tiffany Wakefield
• Jad Joseph Wakim, M.D.
• Wal-Mart Stores, Inc.
• Amber Waldner
• Walgreen Co

• All providers in Rock Springs, WY
• Case Manager/Care Coordinator in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.