MEDICARE: HALEY ELIZABETH WAGNER MSN, APRN, FNP-C

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	363LF0000X	Family Nurse Practitioner	4008952	KY

General Provider Information

NPI Number	:	1073398624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY ELIZABETH WAGNER MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	431 REDDING RD STE 140
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-2551
Country	:	US
Telephone Number	:	859-226-2500
Fax Number	:	859-280-2595

Provider Business Practice Location Address
First Line	:	431 REDDING RD STE 140
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-2551
Country	:	US
Telephone Number	:	859-226-2500
Fax Number	:	859-280-2595

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

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	10/31/2023

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