DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: GABRIELLE KYRA WAGNER

MEDICARE: GABRIELLE KYRA WAGNER
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
1363AM0700XMedical Physician AssistantWV

General Provider Information

NPI Number : 1366385940
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIELLE KYRA WAGNER
Provider Business Mailing Address
First Line : 36 OVERLOOK DR
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-1022
Country : US
Telephone Number : 304-677-0114
Fax Number :
Provider Business Practice Location Address
First Line : 3200 MACCORKLE AVE SE
Second Line :
City : CHARLESTON
State : WV
Zip : 25304-1227
Country : US
Telephone Number : 304-388-5432
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2026
Last Update Date : 04/10/2026

Similar Medicare Providers

1639815889 — JOSEPH MICHAEL BLUMER D.O.
Practice Location Address:
3200 MACCORKLE AVE SE
CHARLESTON, WV
25304-1227
Practice Phone: 304-388-4172
Practice Fax: 304-388-4155
1427619766 — TAEYEONG KO MD
Practice Location Address:
3200 MACCORKLE AVE SE
CHARLESTON, WV
25304-1227
Practice Phone: 304-388-5432
Practice Fax:
1497490304 — DR. THOMAS WILLIAM KNOWLES DO
Practice Location Address:
3200 MACCORKLE AVE SE
CHARLESTON, WV
25304-1227
Practice Phone: 520-263-2000
Practice Fax:
1104769801 — AMANDA MANNON
Practice Location Address:
3200 MACCORKLE AVE SE
CHARLESTON, WV
25304-1227
Practice Phone: 304-388-5432
Practice Fax:
1417890005 — ZACHARY DAVID FOSTER RN
Practice Location Address:
3200 MACCORKLE AVE SE
CHARLESTON, WV
25304-1227
Practice Phone: 304-388-4397
Practice Fax:
1265435556 — MRS. TINA NANNETTE SHANNON CRNA
Practice Location Address:
3200 MACCORKLE AVE SE
CHARLESTON, WV
25304-1227
Practice Phone: 304-388-5503
Practice Fax:

Directions to “ GABRIELLE KYRA WAGNER ” 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.