Healthcare Provider Details

I. General information

NPI: 1760316087
Provider Name (Legal Business Name): ANNA WAGNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N COURT ST
CARLISLE AR
72024-9154
US

IV. Provider business mailing address

717 CENTER ST
CARLISLE AR
72024-9335
US

V. Phone/Fax

Practice location:
  • Phone: 501-703-0390
  • Fax:
Mailing address:
  • Phone: 501-773-4528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number224870
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: