Active NPI
Debbie Lynn Waggoner, PHARMD
- Nutrition Support Pharmacist
- Little Rock, AR
National Provider Identifier
1720193063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutrition Support Pharmacist
- License
- 8910
- Practice address
- 4300 W 7TH St
Slot 119
Little Rock, AR 72205-5446 - Phone
- (501) 257-6330
- Fax
- (501) 257-6329
- NPI assigned
- Aug 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutrition Support Pharmacist | 1835N1003X | 8910 | AR | Primary |
Addresses
Primary practice location
4300 W 7TH St
Slot 119
Little Rock, AR 72205-5446
Mailing address
350 Red Oak Airpark
Cabot, AR 72023-8512
Phone (501) 257-6330
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8910 | AR | MD | Nutrition Support Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720193063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 RED OAK AIRPARK",
"city": "CABOT",
"state": "AR",
"postal_code": "720238512",
"telephone_number": "501-257-6330",
"fax_number": "501-257-6329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4300 W 7TH ST",
"address_2": "SLOT 119",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722055446",
"telephone_number": "501-257-6330",
"fax_number": "501-257-6329"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGGONER",
"first_name": "DEBBIE",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1835N1003X",
"taxonomy_group": "",
"desc": "Pharmacist, Nutrition Support",
"state": "AR",
"license": "8910",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.