MEDICARE: MRS. KIMBERLY LUE WAGNER MD

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	2084N0400X	Neurology Physician	DR.0053519	CO

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

General Provider Information

NPI Number	:	1922325497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY LUE WAGNER MD

Provider Business Mailing Address
First Line	:	5825 DELMONICO DR STE 102
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-2243
Country	:	US
Telephone Number	:	303-381-0929
Fax Number	:	303-381-1566

Provider Business Practice Location Address
First Line	:	11700 W 2ND PL STE 255
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-1707
Country	:	US
Telephone Number	:	720-321-8040
Fax Number	:	720-321-8041

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

Provider Enumeration Date	:	04/23/2010
Last Update Date	:	06/02/2026

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