Coral Jane Waggoner, RPSGT, RRT,CCSH,MBA

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

License

PT2013-0001 Issued in NM

Practice address

4700 Jefferson St NE Ste 800
Albuquerque, NM 87109-2132

Phone

(505) 872-6005

Fax

(515) 872-6003

NPI assigned

Apr 3, 2018

Sex

Female

Sole proprietor

Yes

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

Master of Business Administration

State licenses

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

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522713600000",
    "number": "1467958942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1869 MONTARA CT NW",
            "city": "LOS LUNAS",
            "state": "NM",
            "postal_code": "870318384",
            "telephone_number": "505-872-6005",
            "fax_number": "505-872-6003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 JEFFERSON ST NE STE 800",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871092132",
            "telephone_number": "505-872-6005",
            "fax_number": "515-872-6003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "CORAL",
        "middle_name": "JANE",
        "credential": "RPSGT, RRT,CCSH,MBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-03",
        "last_updated": "2018-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other",
            "state": "NM",
            "license": "PT2013-0001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ione Wageley, WHNP/CNM
• Amanda Wagenblast
• Benjamin Lee Wagenman, MD
• Gael Patricia Wager, MD, MPH, MBA
• Linda L.F. Waggener, CNP-BC
• Destiny M Waggoner, PH.D.
• Wende Waggoner, OD, MPH, MS
• Bikal Wagle
• Wagner & Schuman Dental Offices
• Zo Wagner-Henninger

• Other Specialist/Technologist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Other Specialist/Technologist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 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.

Verify at the official NPI Registry.