Kimberly Dawn Wagner, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

34905 Issued in TN

Practice address

100 Lantana Rd Ste 202
Crossville, TN 38555-1903

Phone

(931) 484-5141

NPI assigned

Nov 8, 2023

Last updated

Aug 12, 2026By 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

Enrolled in TN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Covenant Medical Group IncGroup PAC ID 2860305463, 363 clinicians

Ken Homolya MD LLCGroup PAC ID 5799960464, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Covenant Medical Group, Inc.

  • Family Medicine Physician
  • Knoxville, TN
  • NPI 1457302010
  Medicare reassignment Care Compare group NPD
• Iris Medical Group

  • Primary Care Clinic/Center
  • Brentwood, TN
  • NPI 1851025902

  Family

  Medicare reassignment NPD
• Segue Health Partners LLC

  • Family Medicine Physician
  • Cordova, TN
  • NPI 1073040556
  Medicare reassignment NPD
• Heritage Medical Care

  • Primary Care Nurse Practitioner
  • Sparta, TN
  • NPI 1184549693
  NPD (past) Authorized official
• Ken Homolya MD LLC

  • Pain Medicine Physician
  • Hendersonville, TN
  • NPI 1619266814
  Care Compare group
• Covenant Medical Group, Inc

  • Durable Medical Equipment & Medical Supplies
  • Knoxville, TN
  • NPI 1871269415
  NPD
• Associates in Neurology, PLC

  • Specialist
  • Cookeville, TN
  • NPI 1407864242
  NPD (past)
• Iris Wound Care, PC

  • Clinic/Center
  • Brentwood, TN
  • NPI 1568273605
  NPD (past)

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

{
    "created_epoch": "1699401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786492800000",
    "number": "1861266017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 BEN LOMAND DR STE B",
            "city": "SPARTA",
            "state": "TN",
            "postal_code": "385831592",
            "telephone_number": "931-265-4292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LANTANA RD STE 202",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385551903",
            "telephone_number": "931-484-5141"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "521 Ben Lomand Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Sparta",
            "state": "TN",
            "postal_code": "385831592",
            "country_code": "US",
            "telephone_number": "931-265-4292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KIMBERLY",
        "middle_name": "DAWN",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-08",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "34905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q090212",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vascular Wellness Center Inc
• Victor a. Shada, D.O., P.C.
• Vianney Epina Villaruz, MD
• Adrian Vinas
• Jack Monroe Visca
• Cindy Wakham, D.PH.
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0687)
• Wal-Mart Stores East, LP (Vision Center 30-0687)
• Walgreen Co (Rite Aid #11912)
• Walgreen Co (Walgreens #06223)

• Family Nurse Practitioner in Crossville, TN
• Providers in Crossville, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.