Makenzi Wagner

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5619 Issued in OK

Practice address

334 12TH Ave SE
Norman, OK 73071-5070

Phone

(405) 310-6590

NPI assigned

Jul 3, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: wagnerm16@georgefox.edu

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

{
    "created_epoch": "1593734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594166400000",
    "number": "1740807940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412 SW 23RD ST",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731707471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "334 12TH AVE SE",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730715070",
            "telephone_number": "405-310-6590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MAKENZI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-03",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "5619",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "OK",
            "license": "5619",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Wagnerm16@georgefox.edu",
            "affiliation": "N",
            "address_1": "334 12th Ave SE",
            "city": "Norman",
            "state": "OK",
            "country_code": "US",
            "postal_code": "730715070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• April Wages
• Sean Christopher Waggoner, BA
• Christopher G Wagner
• Grace Ellyn Wagner
• Jennifer L Wagner
• Samantha Dyan Wagner, BA
• Taryn Mikelle Wagner, LPC
• Amanda Wahl, RN
• Wal-Mart Stores East , LP
• Wal-Mart Stores East , LP

• Physical Therapist in Norman, OK
• Providers in Norman, OK by specialty
• Physical Therapist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.