William Wagoner, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

124345 Issued in WV

Practice address

1322 Locust Ave
Fairmont, WV 26554-1436

Phone

(304) 366-0700

NPI assigned

Oct 20, 2025

Last updated

Oct 20, 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

Enrolled in WV

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

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• West Virginia University Hospitals, Inc Hospital, Morgantown, WV, CCN 510001

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Monongahela Valley Association of Health Centers, Inc

  dba MVA Fairmont Clinic

  • Federally Qualified Health Center (FQHC)
  • Fairmont, WV
  • NPI 1770697278
  Medicare reassignment NPD
• Monongahela Valley Association of Health Centers, Inc.

  dba MVA Fairmont Clinic Pharmacy

  • Clinic Pharmacy
  • Fairmont, WV
  • NPI 1609979673
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• West Virginia University Hospitals, Inc

  • General Acute Care Hospital
  • Morgantown, WV
  • NPI 1841271459
  Care Compare affiliation

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

{
    "created_epoch": "1760918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760918400000",
    "number": "1710854252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 COWELL ST",
            "city": "WESTOVER",
            "state": "WV",
            "postal_code": "265013809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1322 LOCUST AVE",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265541436",
            "telephone_number": "304-366-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "WILLIAM",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-10-20",
        "last_updated": "2025-10-20",
        "certification_date": "2025-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WV",
            "license": "124345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maximillian Von Doemming
• Karen Sue Waddell
• Kristine Frances-Marie Waddell
• J Keith Wade, OD
• Gena D Wagaman
• Angel Waites
• Gregory Waites, MSW
• Michelle Wakeley, LCSW
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1714)
• Wal-Mart Stores East, L.P. (Vision Center 30-1714)

• Nurse Practitioner in Fairmont, WV
• Providers in Fairmont, WV by specialty
• Nurse Practitioner in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.