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NPI Code Detail

MEDICARE: VONDA KARLA WAGNER MA

MEDICARE: VONDA KARLA WAGNER MA
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
1247200000XOther Technician
2101YP2500XProfessional Counselor3674TN

General Provider Information

NPI Number : 1740450741
Entity Type Code : Individual
Provider Name (Legal Business Name) : VONDA KARLA WAGNER MA
Provider Business Mailing Address
First Line : 1167 SPRATLIN PARK DR
Second Line :
City : GRAY
State : TN
Zip : 37615-6205
Country : US
Telephone Number : 423-467-3600
Fax Number : 423-467-3644
Provider Business Practice Location Address
First Line : 2243 EDDIE WILLIAMS RD
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37601-2872
Country : US
Telephone Number : 423-928-5627
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2008
Last Update Date : 08/10/2016

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Directions to “ VONDA KARLA WAGNER MA” Practice Location

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