Kevin Wagner, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

40475 Issued in TX

Practice address

1977 Butler Blvd Ste E4.400
Houston, TX 77030-4101

Phone

(713) 798-4857

NPI assigned

Apr 8, 2025

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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 and National Provider Directory roles.

• Baylor College of Medicine

  • Ph.D. Medical Genetics
  • Houston, TX
  • NPI 1881026664
  Medicare reassignment NPD
• Baylor College of Medicine

  • Orthopaedic Surgery Physician
  • Sugar Land, TX
  • NPI 1700683844
  NPD

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

{
    "created_epoch": "1744070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1730973124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1977 BUTLER BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770304101",
            "telephone_number": "713-798-3080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1977 BUTLER BLVD STE E4.400",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770304101",
            "telephone_number": "713-798-4857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KEVIN",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-04-08",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "40475",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "40475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley McKenna Wagner, NP
• Holden Wagner, MD
• Jamie Lynn Wagner, D.O.
• Jennifer Wagner, PHARMD
• Kenneth W Wagner, PA-C
• Lisa Donette Wagner, LMSW
• Makaylah Wagner
• Sarah Wagner, RD, MPH
• Shondi Wagner
• Victoria Wagner, MD

• Psychologist in Houston, TX
• Providers in Houston, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.