Kimberly D Wagner, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2004003094 Issued in MO

Practice address

3071 S Grand Ave
Carthage, MO 64836-7851

Phone

(417) 358-4811

Fax

(417) 358-4781

NPI assigned

Mar 22, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kwagner679266@directb.mercy.net

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.

• Freeman-Oak Hill Health System

  • Oxygen Equipment & Supplies (DME)
  • Neosho, MO
  • NPI 1063477800
  NPD (past)
• Freeman-Oak Hill Health System

  • Multi-Specialty Clinic/Center
  • Joplin, MO
  • NPI 1679517023
  NPD (past)
• Orthopaedic Specialists of the Four States LLC

  • Durable Medical Equipment & Medical Supplies
  • Pittsburg, KS
  • NPI 1467799106
  NPD (past)

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252022400000",
    "number": "1992821789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3071 S GRAND AVE",
            "city": "CARTHAGE",
            "state": "MO",
            "postal_code": "648367851",
            "telephone_number": "417-358-4811",
            "fax_number": "417-358-4781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3071 S GRAND AVE",
            "city": "CARTHAGE",
            "state": "MO",
            "postal_code": "648367851",
            "telephone_number": "417-358-4811",
            "fax_number": "417-358-4781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KIMBERLY",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-22",
        "last_updated": "2009-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2004003094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meghan Lynn Vanslyke, RD
• Charles Davin Vaughn, RPH
• Johnny L Venter, DO
• Vitas Laboratory LLC
• Demi Waggoner
• Chad Eric Wagoner, MD
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Megan Weaver

• Physician Assistant in Carthage, MO
• Providers in Carthage, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2009; 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.