BRAD WAGNER (NPI# 1457985053) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457985053 |
| Entity Type | Individual |
| Full Name | BRAD WAGNER |
| Practice Address |
4706 Aero Pkwy Florence KY 41042-2994 |
| Practice Telephone | 5134319305 |
| Enumeration Date | 2020-02-24 |
| Last Update Date | 2020-02-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
AT1725 | KY | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | KENTUCKY BOARD OF MEDICAL LICENSURE | AT1725 | 01 |
| Street Address |
4706 AERO PKWY |
| City | FLORENCE |
| State | KY |
| Zip Code | 41042-2994 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710596010 | Stacey Deann Cruse | Counselor | 71 Cavalier Blvd #303, Florance, KY 41042 | 2020-07-23 |
| 1760044705 | Loretta Macaluso | Speech-Language Pathologist | 1515 Cavalry Drive, Suite 202, Florence, KY 41042 | 2019-06-29 |
| 1659879559 | Christina Shrader | Counselor | 71 Cavalier Blvd Ste 113, Florence, KY 41042 | 2018-01-25 |
| 1891200267 | Rachel Knuehl | Case Manager/Care Coordinator | 8140 Dream Street, Florence, KY 41042 | 2017-12-07 |
| 1427560697 | Marie Nicole Sartori | Nurse Practitioner | 7766 Ewing Blvd Ste 100, Florence, KY 41042 | 2017-10-27 |
| 1669903910 | Northern Kentucky Smiles | Dentist | 1481 Cavalry Drive, Suite 100, Florence, KY 41042 | 2017-03-27 |
| 1306394937 | Mary Austin | Nurse Practitioner | 7766 Ewing Boulevard, Florence, KY 41042 | 2016-09-12 |
| 1598211633 | Samantha Growe | Counselor | 7000 Houston Rd Ste 16, Florence, KY 41042 | 2016-08-29 |
| 1982079299 | Jessica Adelyn Goodridge | Doula | 2224 Forest Lawn Dr., Florence, KY 41042 | 2015-12-11 |
| 1083083414 | Victoria Maruca Havron | Psychologist | 6900 Houston Rd Ste 11, Florence, KY 41042 | 2015-09-16 |
| Find all providers in zip 41042 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881247856 | Julia Marie Hoffmann | Specialist/Technologist | 10095 Investment Way Ste 1, Florence, KY 41042-4798 | 2019-07-18 |
| 1184188286 | Sharon Wilson | Specialist/Technologist | 4116 Conner Dr, Florence, SC 29501-8697 | 2019-01-23 |
| 1548733801 | Ryan Crane | Specialist/Technologist | 223 Harrington Ln, Florence, AL 35630-6613 | 2019-01-09 |
| 1851810261 | Daijavon Jaquita Mccall | Specialist/Technologist | 1207 Malloy Street, Florence, SC 29506 | 2017-09-18 |
| 1225566508 | Phillip Alexander Holbrooks | Specialist/Technologist | 738 Coventry Ln Apt E, Florence, SC 29501-8869 | 2017-05-31 |
| 1124477492 | David Heim | Specialist/Technologist | 1747 Progress St, Florence, SC 29501-6525 | 2016-06-08 |
| 1831556406 | Christopher Michael Harp | Specialist/Technologist | 8200 N Dilcrest Cir, Florence, KY 41042-9631 | 2016-01-27 |
| 1649645037 | Reghan Boehmke | Specialist/Technologist | 4622 E Palmetto St, Florence, SC 29502 | 2015-12-10 |
| 1902280860 | Michael Rice | Specialist/Technologist | 159 Millstone Rd Apt A, Florence, SC 29505-3965 | 2015-07-10 |
| 1952707515 | Holly Hatfield | Specialist/Technologist | 661 Poor Farm Rd, Florence, SC 29505-5726 | 2014-11-10 |
| Find all providers in FLORENCE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.