Jessie Wagner, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

94-11789 Issued in KS

Practice address

3901 Rainbow Blvd, Mailstop 4034
Kansas City, KS 66160

Phone

(913) 588-1908

NPI assigned

Apr 1, 2024

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

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1619729068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 RAINBOW BLVD, MAILSTOP 4034",
            "city": "KANSAS CITY",
            "state": "KS",
            "postal_code": "66160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 RAINBOW BLVD, MAILSTOP 4034",
            "city": "KANSAS CITY",
            "state": "KS",
            "postal_code": "66160",
            "telephone_number": "913-588-1908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JESSIE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-01",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "94-11789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Joseph Waddell II, MD
• Melanie Wade, N.P.
• Peggy Ellen Waggoner, MA
• Benjamin William Martin Wagner, PHARMD
• Gerit Wagner
• Leigh Elizabeth Wagner, RD, LD
• Joseph Wahl, DO
• Lisa Marie Wainscott, OTR/L, CLT, CDP
• Katelyn Marie Waits, APRN
• Bryan Wakefield, MD

• Family Medicine Physician in Kansas City, KS
• Providers in Kansas City, KS by specialty
• Family Medicine Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.