Samantha Ann Wagner, ATC, LAT, CES

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

914 Issued in OK

Practice address

170 Athletic Ctr
Stillwater, OK 74078-0001

Phone

(405) 744-7823

NPI assigned

Feb 29, 2016

Last updated

Feb 29, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1456704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456704000000",
    "number": "1770943078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4599 N WASHINGTON ST",
            "address_2": "APT 4F",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740751278",
            "telephone_number": "937-308-6354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 ATHLETIC CTR",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740780001",
            "telephone_number": "405-744-7823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "SAMANTHA",
        "middle_name": "ANN",
        "credential": "ATC, LAT, CES",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-29",
        "last_updated": "2016-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OK",
            "license": "914",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OKLAHOMA STATE BOARD OF MEDICAL LICENSURE AND SUPERVISION",
            "identifier": "914",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Stillwater, OK
• Providers in Stillwater, OK by specialty
• Athletic Trainer in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2016; 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.