Kelly Wagenheim

Primary specialty

PharmacistTaxonomy code 183500000X

License

5302411047 Issued in MI

Practice address

21400 Perry Ave
Big Rapids, MI 49307-9262

Phone

(231) 796-3691

Fax

(231) 796-8722

NPI assigned

Jun 22, 2016

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

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": "1466553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466553600000",
    "number": "1831540665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21400 PERRY AVE",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493079262",
            "telephone_number": "231-796-3691",
            "fax_number": "231-796-8722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21400 PERRY AVE",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493079262",
            "telephone_number": "231-796-3691",
            "fax_number": "231-796-8722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENHEIM",
        "first_name": "KELLY",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-22",
        "last_updated": "2016-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302411047",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS 34800",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Big Rapids, MI
• Providers in Big Rapids, MI by specialty
• Pharmacist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 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.