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NPI Code Detail

MEDICARE: RACHEL WAGNER RD

MEDICARE: RACHEL WAGNER RD
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
1133V00000XRegistered Dietitian169038KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1K224130OTHERKYMEDICARE

General Provider Information

NPI Number : 1275066953
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL WAGNER RD
Provider Business Mailing Address
First Line : PO BOX 635283
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-5283
Country : US
Telephone Number : 859-212-4625
Fax Number : 859-212-4638
Provider Business Practice Location Address
First Line : 1400 GRAND AVE
Second Line :
City : NEWPORT
State : KY
Zip : 41071-2570
Country : US
Telephone Number : 859-572-3366
Fax Number : 859-572-3568
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2017
Last Update Date : 01/08/2026

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