Active NPI
Audra Wagaman, PSYD
- Psychologist
- North Charleston, SC
National Provider Identifier
1447762240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1481
- Practice address
- 9229 University Blvd
BLDG F, Suite 2a
North Charleston, SC 29406 - Phone
- (843) 789-6400
- NPI assigned
- Nov 2, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1481 | SC | Primary |
Addresses
Primary practice location
9229 University Blvd
BLDG F, Suite 2a
North Charleston, SC 29406
Mailing address
9229 University Blvd
BLDG F, Suite 2a
North Charleston, SC 29406
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1481 | SC | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1509580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532563200000",
"number": "1447762240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9229 UNIVERSITY BLVD",
"address_2": "BLDG F, SUITE 2A",
"city": "NORTH CHARLESTON",
"state": "SC",
"postal_code": "29406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9229 UNIVERSITY BLVD",
"address_2": "BLDG F, SUITE 2A",
"city": "NORTH CHARLESTON",
"state": "SC",
"postal_code": "29406",
"telephone_number": "843-789-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGAMAN",
"first_name": "AUDRA",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-02",
"last_updated": "2018-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "SC",
"license": "1481",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.