Anthony Mark Wagner, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11134 Issued in TN

Practice address

210 Simmons St
Maryville, TN 37801

Phone

(865) 970-9800

Fax

(865) 983-4518

NPI assigned

Dec 27, 2006

Last updated

May 29, 2018By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Parkwest Medical Center

  dba Peninsula Outpatient Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Maryville, TN
  • NPI 1699757609
  NPD (past)

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527552000000",
    "number": "1659436830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 CENTERPOINT BLVD STE 158",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379321966",
            "telephone_number": "865-374-5806",
            "fax_number": "865-374-9004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 SIMMONS ST",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "37801",
            "telephone_number": "865-970-9800",
            "fax_number": "865-983-4518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ANTHONY",
        "middle_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2018-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN129889 NP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "11134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1514002",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James H Vinson, MD
• Danielle Stephanie Vittatoe, FNP-BC
• Donna Voica, APN
• Kaitlyn Voss
• Emily Waggoner
• Carl Wagner, MD
• Wal-Mart Stores East LP (Walmart Pharmacy 10-4223)
• Wal-Mart Stores East, L.P. (Vision Center 30-4223)
• Wal-Mart Stores East, LP (Walmart Vision Center 30-7239)
• Wal-Mart Stores East, LP (Walmart Pharmacy 10-7239)

• Family Nurse Practitioner in Maryville, TN
• Providers in Maryville, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2018; 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.