Healthcare Provider Details

I. General information

NPI: 1851223267
Provider Name (Legal Business Name): EMILY WAGONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MAIN ST STE 206
N LITTLE ROCK AR
72114-4918
US

IV. Provider business mailing address

301 MAIN ST STE 206
N LITTLE ROCK AR
72114-4918
US

V. Phone/Fax

Practice location:
  • Phone: 866-700-1606
  • Fax: 866-338-5921
Mailing address:
  • Phone: 866-700-1606
  • Fax: 866-338-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: