Active NPI
Tyler Wagnon, HIS
- Hearing Instrument Specialist
- Shreveport, LA
National Provider Identifier
1982161659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hearing Instrument Specialist
- License
- 1268
- Practice address
- 425 Ashley Ridge Blvd
Shreveport, LA 71106-7226 - Phone
- (318) 797-3311
- NPI assigned
- Feb 28, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hearing Instrument Specialist | 237700000X | 1268 | LA | Primary |
Addresses
Primary practice location
425 Ashley Ridge Blvd
Shreveport, LA 71106-7226
Mailing address
494 Ockley Dr
Shreveport, LA 71105-2920
Phone (318) 840-6414
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551312000000",
"number": "1982161659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "494 OCKLEY DR",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711052920",
"telephone_number": "318-840-6414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 ASHLEY RIDGE BLVD",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711067226",
"telephone_number": "318-797-3311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNON",
"first_name": "TYLER",
"credential": "HIS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-02-28",
"last_updated": "2019-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "237700000X",
"taxonomy_group": "",
"desc": "Hearing Instrument Specialist",
"state": "LA",
"license": "1268",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.