Thomas Wagoner, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

57668 Issued in KY

Practice address

201 S 5TH St
Bardstown, KY 40004-1142

Phone

(502) 348-6309

Fax

(502) 348-2793

NPI assigned

Mar 24, 2016

Last updated

Feb 24, 2025By 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)

Enrolled

Credentials

Doctor of Medicine

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.

• Bardstown Primary Care, PLLC

  dba Physicians to Children & Adolescents

  • Rural Health Clinic/Center
  • Bardstown, KY
  • NPI 1053305524

  Pediatrics

  NPD (past)
• Flaget Healthcare, Inc

  dba CHI Saint Joseph Health - Flaget Memorial Hospital

  • General Acute Care Hospital
  • Bardstown, KY
  • NPI 1871588772
  NPD (past)

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

{
    "created_epoch": "1458777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1598127862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S 5TH ST",
            "city": "BARDSTOWN",
            "state": "KY",
            "postal_code": "400041142",
            "telephone_number": "502-348-6309",
            "fax_number": "502-348-2793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S 5TH ST",
            "city": "BARDSTOWN",
            "state": "KY",
            "postal_code": "400041142",
            "telephone_number": "502-348-6309",
            "fax_number": "502-348-2793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-24",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "57668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald Doyle Tyler, MD
• Lynda Onyinyechi Uzonwune, PHARMD
• Alicia Vincent, OTR/L
• Dale Vincent, APRN
• Jacob William Vincent, MD
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0729)
• Wal-Mart Stores East, LP (Vision Center 30-0729)
• Walgreen Co (Walgreens #11307)
• Jacqueline Hamilton Walker, OTR/L
• Amy A. Walls, OTR/L

• Pediatrics Physician in Bardstown, KY
• Providers in Bardstown, KY by specialty
• Pediatrics Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; 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.