MEDICARE: ALISHIA ANN WAGGONER 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	53-83284-031	KS

General Provider Information

NPI Number	:	1649013772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISHIA ANN WAGGONER FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 1832
Second Line	:
City	:	PITTSBURG
State	:	KS
Zip	:	66762-1832
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 N PENNSYLVANIA AVE
Second Line	:
City	:	INDEPENDENCE
State	:	KS
Zip	:	67301-2222
Country	:	US
Telephone Number	:	620-331-2400
Fax Number	:

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

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	08/27/2025

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