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NPI Code Detail

MEDICARE: KASSEY WAGNER

MEDICARE: KASSEY WAGNER
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1740125103
Entity Type Code : Individual
Provider Name (Legal Business Name) : KASSEY WAGNER
Provider Business Mailing Address
First Line : 401 MATTHEW ST
Second Line :
City : MARIETTA
State : OH
Zip : 45750-1635
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 401 MATTHEW ST
Second Line :
City : MARIETTA
State : OH
Zip : 45750-1635
Country : US
Telephone Number : 740-568-5669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2026
Last Update Date : 04/22/2026

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Directions to “ KASSEY WAGNER ” Practice Location

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