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NPI Code Detail

MEDICARE: KENT R WAGNER PA

MEDICARE: KENT R WAGNER PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant1500742KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629062302
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENT R WAGNER PA
Provider Business Mailing Address
First Line : 311 E SPRUCE ST
Second Line :
City : GARDEN CITY
State : KS
Zip : 67846-5679
Country : US
Telephone Number : 620-275-3700
Fax Number :
Provider Business Practice Location Address
First Line : 311 E SPRUCE ST
Second Line :
City : GARDEN CITY
State : KS
Zip : 67846-5679
Country : US
Telephone Number : 620-275-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2005
Last Update Date : 04/25/2013

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Directions to “ KENT R WAGNER PA” Practice Location

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