Kelly Ann Wagner, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

302197-031 Issued in WI

Practice address

1143 Vogt Dr Apt 14
West Bend, WI 53095-5505

Phone

(262) 483-8439

Fax

(262) 353-3484

NPI assigned

Sep 28, 2009

Last updated

Sep 28, 2009By the provider in NPPES

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

State licenses

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

{
    "created_epoch": "1254096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254096000000",
    "number": "1407180268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1143 VOGT DR APT 14",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530955505",
            "telephone_number": "262-483-8439",
            "fax_number": "262-353-3484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1143 VOGT DR APT 14",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530955505",
            "telephone_number": "262-483-8439",
            "fax_number": "262-353-3484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-28",
        "last_updated": "2009-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WI",
            "license": "302197-031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Vogt
• Raeann Volbright
• Brett Vollmer, DPT
• Lisa Vorwerk, COTA
• Jill Wagner, RN, RCS
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2658)
• Wal-Mart Stores East, LP (Vision Center 30-2658)
• Tanya Marie Wald, ATR, LPC
• Angela R Waldoch, M.S.
• Walgreen Co (Walgreens #13088)

• Licensed Practical Nurse in West Bend, WI
• Providers in West Bend, WI by specialty
• Licensed Practical Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2009; 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.