Keith William Wagoner, BSN, RN-BC

Primary specialty

Gerontology Registered NurseTaxonomy code 163WG0600X

License

919371 Issued in TX

Practice address

110 N State Highway 274
Kemp, TX 75143-4617

Phone

(430) 255-2199

NPI assigned

Sep 20, 2024

Last updated

Sep 20, 2024By the provider in NPPES

Sex

Male

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

Credentials

Bachelor on Science - Nursing

State licenses

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

{
    "created_epoch": "1726790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726790400000",
    "number": "1407673593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 ARAPAHO TRL",
            "city": "MABANK",
            "state": "TX",
            "postal_code": "751569176",
            "telephone_number": "903-603-3979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N STATE HIGHWAY 274",
            "city": "KEMP",
            "state": "TX",
            "postal_code": "751434617",
            "telephone_number": "430-255-2199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "KEITH",
        "middle_name": "WILLIAM",
        "credential": "BSN, RN-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-20",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "TX",
            "license": "919371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah L Smith
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• Theobald Medical Center LLC
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• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-2349)
• West Wharton County Hospital District (Kemp Care Center)

• Gerontology Registered Nurse in Kemp, TX
• Providers in Kemp, TX by specialty
• Gerontology Registered Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2024; 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.