MEDICARE: TYLER WAGNON HIS

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
1	237700000X	Hearing Instrument Specialist	1268	LA

General Provider Information

NPI Number	:	1982161659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER WAGNON HIS

Provider Business Mailing Address
First Line	:	494 OCKLEY DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2920
Country	:	US
Telephone Number	:	318-840-6414
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 ASHLEY RIDGE BLVD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-7226
Country	:	US
Telephone Number	:	318-797-3311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2019
Last Update Date	:	02/28/2019

Similar Medicare Providers

1871523902 — AMEDISYS LOUISIANA, LLC
Practice Location Address:

425 ASHLEY RIDGE BLVD , SUITE 246
SHREVEPORT, LA
71106-7226

Practice Phone: 318-865-8865
Practice Fax: 318-865-0104

1366443830 — AMEDISYS HOSPICE, LLC
Practice Location Address:

425 ASHLEY RIDGE BLVD , SUITE 240
SHREVEPORT, LA
71106-7226

Practice Phone: 318-868-8788
Practice Fax: 318-868-9788

1780105908 — LHCG CVIII, LLC
Practice Location Address:

425 ASHLEY RIDGE BLVD STE 330A
SHREVEPORT, LA
71106-7226

Practice Phone: 318-383-6745
Practice Fax: 318-383-6747

1013439447 — LHCG CIX, LLC
Practice Location Address:

425 ASHLEY RIDGE BLVD STE 330B
SHREVEPORT, LA
71106-7226

Practice Phone: 318-383-6748
Practice Fax: 318-383-6750

1477201945 — MRS. ANDREA MEREDITH WALTERS MSN, APRN FNP-C
Practice Location Address:

425 ASHLEY RIDGE BLVD STE 330C
SHREVEPORT, LA
71106-7226

Practice Phone: 318-399-7520
Practice Fax: 318-399-7521

1376092593 — MRS. ERICA NICOLE SIMMONS MHP
Practice Location Address:

4209 SOUTHAMPTON RD
SHREVEPORT, LA
71119-7226

Practice Phone: 318-562-0087
Practice Fax:

Directions to “ TYLER WAGNON HIS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.