Ebony Wagner

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

2013023536 Issued in MO

Practice address

2325 Patterson Rd
Florissant, MO 63031-2205

Phone

(314) 620-5553

Fax

(314) 584-5002

NPI assigned

Aug 19, 2016

Last updated

Aug 19, 2016By 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

Practice roles

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

• Caring Moments Home Health LLC

  • Health Maintenance Organization
  • Florissant, MO
  • NPI 1831641430
  NPD (past) Authorized official
• Caring Moments in-Home Health LLC

  dba Caring Moments Home Health

  • Home Health Agency
  • Black Jack, MO
  • NPI 1730753377
  NPD

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

{
    "created_epoch": "1471564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471564800000",
    "number": "1417402397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2325 PATTERSON RD",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630312205",
            "telephone_number": "314-620-5553",
            "fax_number": "314-584-5002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2325 PATTERSON RD",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630312205",
            "telephone_number": "314-620-5553",
            "fax_number": "314-584-5002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "EBONY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-19",
        "last_updated": "2016-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MO",
            "license": "2013023536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendy Vogel, PHARMD
• Luana Von Hall
• Madison Rose Vonarx
• Maria Vuch, SLP
• Natasha Wade
• Erica Wagner, DPT
• Molly Wagner, OTR/L
• Murphy Wair Jr.
• Wal-Mart Stores East LP (Walmart Pharmacy 10-5927)
• Wal-Mart Stores East, LP (Walmart Vision Center 30-5927)

• Licensed Practical Nurse in Florissant, MO
• Providers in Florissant, MO by specialty
• Licensed Practical Nurse in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2016; 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.