Abigail Wagnon

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Practice address

231 E Graham Ave
Pryor, OK 74361-2436

Phone

(918) 418-3691

NPI assigned

Sep 23, 2019

Sex

Female

Sole proprietor

No

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 OK

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

Specialty

Marriage and Family Therapist

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

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 and National Provider Directory roles.

• Grand Lake Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Miami, OK
  • NPI 1497762520
  Medicare reassignment
• Grand Lake Mental Health Center, Inc.

  • Community/Behavioral Health Agency
  • Tulsa, OK
  • NPI 1356048656
  NPD
• Grand Lake Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pryor, OK
  • NPI 1871500900
  NPD

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

{
    "created_epoch": "1569196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1962053835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 E GRAHAM AVE",
            "city": "PRYOR",
            "state": "OK",
            "postal_code": "743612436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 E GRAHAM AVE",
            "city": "PRYOR",
            "state": "OK",
            "postal_code": "743612436",
            "telephone_number": "918-418-3691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNON",
        "first_name": "ABIGAIL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-23",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "OK",
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vialife Hospice LLC
• Mitchell Donovan Vo
• Delores Jane Voth, ARNP
• Stacie Vunetich, LMSW
• Bryon Keith Wade Jr.
• Wagoner Mobility & Medical
• Wal-Mart Stores East LP
• Walgreen Co
• Lori Beth Walker
• Justin Dale Wallace

• Marriage & Family Therapist in Pryor, OK
• Providers in Pryor, OK by specialty
• Marriage & Family Therapist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; 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.