MEDICARE: DONNELLE I. WAGNER DNP

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	ATP000123	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225213812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNELLE I. WAGNER DNP

Provider Business Mailing Address
First Line	:	4620 ROGERS AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3149
Country	:	US
Telephone Number	:	479-384-5380
Fax Number	:	479-384-5382

Provider Business Practice Location Address
First Line	:	4620 ROGERS AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3149
Country	:	US
Telephone Number	:	479-384-5380
Fax Number	:	479-384-5382

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

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	09/13/2024

Similar Medicare Providers

1194776344 — DR. JUDITH BYNUM GRIMM M.D.
Practice Location Address:

4600 ROGERS AVE
FORT SMITH, AR
72903-3149

Practice Phone: 479-494-7443
Practice Fax:

1396133393 — MEDEXPRESS URGENT CARE ARKANSAS, P.A.
Practice Location Address:

4600 ROGERS AVE
FORT SMITH, AR
72903-3149

Practice Phone: 479-494-7443
Practice Fax: 479-494-7451

1972450344 — ANCHORR OF HOPE LLC
Practice Location Address:

2634 RIVER COVE TRL
FORT WAYNE, IN
46825-3149

Practice Phone: 463-303-4786
Practice Fax:

1083799209 — CHIRONET, L.L.C.
Practice Location Address:

3149 LACKLAND RD , #104
FORT WORTH, TX
76116-4109

Practice Phone: 817-886-8890
Practice Fax: 817-886-8891

1720452071 — CHRISTOPHER NGUYEN
Practice Location Address:

609 HEMPHILL ST , SUITE 101
FORT WORTH, TX
76104-3149

Practice Phone: 817-923-8484
Practice Fax: 817-923-8494

1760927172 — DEEPA TONY ABRAHAM
Practice Location Address:

609 HEMPHILL ST
FORT WORTH, TX
76104-3149

Practice Phone: 817-923-8484
Practice Fax:

Directions to “ DONNELLE I. WAGNER DNP” 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.