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General NPI Number Information
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NPI Number | 1164691465
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Entity Type | Individual
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Provider Name | KIMBERLY H WAGNER R.N., F.N.P
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Gender | Female
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 125 W INTERSTATE 30
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City | ROYSE CITY
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State | TX
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Zip | 75189-7512
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Country | US
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Telephone | 903-408-7700
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Fax | 903-408-7810
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Provider Business Mailing Address
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Address Line | 4211 JOE RAMSEY BLVD E SUITE 100
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City | GREENVILLE
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State | TX
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Zip | 75401-7852
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Country | US
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Telephone | 903-408-7710
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Fax | 903-408-7810
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN 603948
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP116554
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License Number State | TX
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