Kayla Riley Wagoner, PTA

Key facts

NPI

1669140604

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapy Assistant 225200000X

Practice address

1016 Fletcher St
Wilkesboro, NC 28697-9472

Phone

(336) 667-9261

NPI assigned

Sep 3, 2021

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 3, 2021.

{
    "created_epoch": "1630627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630627200000",
    "number": "1669140604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 FLETCHER ST",
            "city": "WILKESBORO",
            "state": "NC",
            "postal_code": "286979472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 FLETCHER ST",
            "city": "WILKESBORO",
            "state": "NC",
            "postal_code": "286979472",
            "telephone_number": "336-667-9261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "KAYLA",
        "middle_name": "RILEY",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-03",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Wilkesboro, NC · Physical Therapy Assistant in North Carolina