TRACI WAGONER (NPI# 1568715712) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568715712 |
| Entity Type | Individual |
| Full Name | TRACI WAGONER |
| Practice Address |
2022 Dorsett Vlg Maryland Heights MO 63043-2208 |
| Mailing Address |
120 Park Charles Blvd N Saint Peters MO 63376-3214 |
| Practice Telephone | 3145900520 |
| Mailing Telephone | 6369220850 |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2016-06-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
2012033129 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2022 DORSETT VLG |
| City | MARYLAND HEIGHTS |
| State | MO |
| Zip Code | 63043-2208 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962980979 | Mary Elizabeth Pagano | Registered Nurse | 2022 Dorsett Vlg, Maryland Heights, MO 63043-2208 | 2018-08-01 |
| 1295253359 | Helen Evans | Nurse Practitioner | 2022 Dorsett Vlg, Maryland Heights, MO 63043-2208 | 2017-09-08 |
| 1699211748 | Alexandra Giddens | Nurse Practitioner | 2022 Dorsett Vlg, Maryland Heights, MO 63043-2208 | 2017-01-13 |
| 1922455336 | Jessica Ann Kesterson | Nurse Practitioner | 2022 Dorsett Vlg, Maryland Heights, MO 63043-2208 | 2016-05-16 |
| 1548660871 | Katherine Chambers | Physician Assistant | 2022 Dorsett Vlg, Maryland Heights, MO 63043-2208 | 2014-08-22 |
| 1144659632 | Matthew Hammer | Registered Nurse | 2022 Dorsett Vlg, Maryland Heights, MO 63043-2208 | 2013-11-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861026098 | Sana Lake Recovery Center, LLC | Community/Behavioral Health | 140 Weldon Parkway, Maryland Heights, MO 63043 | 2020-02-26 |
| 1124658257 | Amadu Barrie | Nurse Practitioner | 134 Midland Avenue, Maryland Heights, MO 63043 | 2020-01-16 |
| 1770004707 | Taylor Anne Jordan | Specialist/Technologist | 1885 Mckelvey Hill Dr., Apt 303, Maryland Heights, MO 63043 | 2017-06-29 |
| 1528507167 | Erica K Mazurkiewicz | Counselor | 12061 Dorsett, Maryland Heights, MO 63043 | 2017-02-15 |
| 1851756217 | Crpt, LLC | Physical Therapist | 12674 Dorsett Road, Maryland Heights, MO 63043 | 2015-12-29 |
| 1871930032 | Rachel Michele Gill | Chiropractor | 11d Worthington Access Dr., St. Louis, MO 63043 | 2013-05-29 |
| 1487913299 | John Martin Dds | Dentist | 12131 Dorsett, St 211, Maryland Heights, MO 63043 | 2012-05-14 |
| 1518287648 | Pharmacy Services Inc. | Pharmacist | 212 Millwell Dr., Suite A, St. Louis, MO 63043 | 2010-06-11 |
| 1447578000 | Rxoutreach | Pharmacy | 3171-3183 Riverport Tech Center Dr, Maryland Heights, MO 63043 | 2010-05-06 |
| 1811129257 | Gene Paul Barbour | Internal Medicine | 1 Reading, Marilyn Heights, MO 63043 | 2009-08-19 |
| Find all providers in zip 63043 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851999585 | Heather Hupperts-harman | Nurse Practitioner | 11826 Mckelvey Gardens Dr, Maryland Heights, MO 63043-2229 | 2020-10-14 |
| 1780281618 | Czerina Rivera | Nurse Practitioner | 2935 Sprucewood Dr, Maryland Heights, MO 63043-1381 | 2020-10-04 |
| 1376084780 | Portia Price | Nurse Practitioner | 11982 Brookmont Dr, Maryland Heights, MO 63043-1307 | 2017-03-17 |
| 1265980460 | Becky Simpson | Nurse Practitioner | 3065 Donnycave Ln, Maryland Heights, MO 63043-1369 | 2016-09-15 |
| 1467007898 | Jennifer Elizabeth Marlatt | Nurse Practitioner | 2024 Dorsett Vlg, Maryland Heights, MO 63043-2208 | 2019-08-02 |
| 1376030759 | Sonia Mejia-ray | Nurse Practitioner | 13655 Riverport Dr, Maryland Heights, MO 63043-4812 | 2018-04-20 |
| 1295253359 | Helen Evans | Nurse Practitioner | 2022 Dorsett Vlg, Maryland Heights, MO 63043-2208 | 2017-09-08 |
| 1699211748 | Alexandra Giddens | Nurse Practitioner | 2022 Dorsett Vlg, Maryland Heights, MO 63043-2208 | 2017-01-13 |
| 1922455336 | Jessica Ann Kesterson | Nurse Practitioner | 2022 Dorsett Vlg, Maryland Heights, MO 63043-2208 | 2016-05-16 |
| 1083917330 | Anneka Kafi Pillow | Nurse Practitioner | 13655 Riverport Dr, Office 438, Maryland Heights, MO 63043-4812 | 2010-12-08 |
| Find all providers in MARYLAND HEIGHTS | ||||
| City | MARYLAND HEIGHTS |
| Zip Code | 63043 |
Please comment or provide details below to improve the information on TRACI WAGONER.
| 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.