Active NPI
Sean M. Wagner, LCP
- Clinical Psychologist
- Kingman, KS
National Provider Identifier
1497852370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0196
- Practice address
- 760 W D Ave
Kingman, KS 67068-1266 - Phone
- (620) 532-3895
- NPI assigned
- Sep 20, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0196 | KS | Primary |
Addresses
Primary practice location
760 W D Ave
Kingman, KS 67068-1266
Mailing address
419 E C Ave
Kingman, KS 67068-1622
Phone (620) 532-2513
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 393288 | Other | KS | BCBS |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0196 | KS | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497852370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "419 E C AVE",
"city": "KINGMAN",
"state": "KS",
"postal_code": "670681622",
"telephone_number": "620-532-2513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "760 W D AVE",
"city": "KINGMAN",
"state": "KS",
"postal_code": "670681266",
"telephone_number": "620-532-3895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "SEAN",
"middle_name": "M.",
"credential": "LCP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KS",
"license": "0196",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "393288",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kingman, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.