KELLY JO WAGNER (NPI# 1861738981) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861738981 |
| Entity Type | Individual |
| Full Name | KELLY JO WAGNER |
| Practice Address |
12650 W 64th Ave Unit E501 Arvada CO 80004-3893 |
| Mailing Address |
6595 Zinnia St Arvada CO 80004-2256 |
| Practice Telephone | 3034314127 |
| Practice Fax Number | 3034314553 |
| Mailing Telephone | 9372431014 |
| Enumeration Date | 2012-12-17 |
| Last Update Date | 2016-03-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
0990570 | CO | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013570746 | Kelly Susan Wagner | Speech-Language Pathologist | 8902 Old Harford Rd, Baltimore, MD 21234-2646 | 2019-04-18 |
| 1356808455 | Kelly Mcmahon Wagner | Social Worker | 4701 Greenspring Ave, Baltimore, MD 21209-4704 | 2019-02-25 |
| 1659744316 | Kelly Ann Wagner | Nurse Practitioner | 10410 Abercorn Expressway, Savannah, GA 31419 | 2015-11-03 |
| 1659612745 | Kelly Ann Wagner | Specialist | 727 Carmen Dr, Norristown, PA 19401-3545 | 2013-03-14 |
| 1881925592 | Kelly Danielle Wagner | Physical Therapy Assistant | 226 Fish Hall Rd, Brunswick, GA 31523-7405 | 2010-01-20 |
| 1407180268 | Kelly Ann Wagner | Licensed Practical Nurse | 1143 Vogt Dr Apt 14, West Bend, WI 53095-5505 | 2009-09-28 |
| 1295288629 | Kelly Wagner | Dietitian, Registered | 200 Hawkins Dr, Food and Nutrition Services, W146 Gh, Iowa City, IA 52242-1009 | 2016-08-02 |
| 1154776334 | Kelly Wagner | Student in an Organized Health Care Education/Training Program | 100 High St, C 378, Buffalo, NY 14203-1126 | 2016-04-26 |
| 1346613205 | Kelly Wagner | Naturopath | 185 Tilley Dr, Suite #51, South Burlington, VT 05403-4484 | 2015-11-01 |
| 1932510831 | Kelly Wagner | Pharmacist | 3360 Tittabawassee Rd, Saginaw, MI 48604-9453 | 2014-05-13 |
| Street Address |
12650 W 64TH AVE UNIT E501 |
| City | ARVADA |
| State | CO |
| Zip Code | 80004-3893 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659491546 | Perfect Teeth - 64th and Ward P.C. | Dentist | 12650 W 64th Ave, Unit J, Arvada, CO 80004-3893 | 2007-04-02 |
| 1861867632 | Jill Marie Brogdon | Registered Nurse | 12650 W 64th Ave, Unit 501, Arvada, CO 80004-3893 | 2015-12-04 |
| 1306241278 | Leah Jones | Nurse Practitioner | 12650 W 64th Ave, Suite E501, Arvada, CO 80004-3893 | 2014-11-04 |
| 1558760579 | Paul Casey | Dentist | 12650 W 64th Ave, Arvada, CO 80004-3893 | 2014-08-14 |
| 1619390051 | Beth Damstedt | Physician Assistant | 12650 W 64th Ave, Unit E501, Arvada, CO 80004-3893 | 2014-01-21 |
| 1578831137 | Megan Mohatt | Physician Assistant | 12650 W 64th Ave, Unit E501, Arvada, CO 80004-3893 | 2011-12-09 |
| 1447555016 | Joshua Aaron Bezecny | Physician Assistant | 12650 W 64th Ave, Unit E501, Arvada, CO 80004-3893 | 2011-01-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326503194 | Flynn Behavior Associates | Behavioral Analyst | 13185 W 62nd Place, Arvada, CO 80004 | 2019-02-06 |
| 1124543384 | Zoe Denver Nelson | Counselor | 9850 W 59th Pl, Arvada, CO 80004 | 2017-08-09 |
| 1982134573 | Cynthia Jean Keefover | Physical Therapy Assistant | 6625 Union St, Arvada, CO 80004 | 2017-06-15 |
| 1235680257 | Uma Sitaula | Nurse Practitioner | 12650 W 64th Ave Unit E 105, Arvada, CO 80004 | 2016-10-14 |
| 1124494091 | Alan Ross Hofman | Physical Therapist | 5945 Ward Rd Ste 110, Arvada, CO 80004 | 2015-08-14 |
| 1770969917 | Jennifer Lynn Johnson | Day Training/Habilitation Specialist | 6725 Yarrow St., Arvada, CO 80004 | 2015-08-10 |
| 1649680414 | Johanna Meister | Community Health Worker | 7603 Robinson Way, Arvada, CO 80004 | 2014-05-02 |
| 1922346915 | Ashley L Saylor | Chiropractor | 10050 Ralston Rd. Suite E, Arvada, CO 80004 | 2013-01-25 |
| 1225382906 | Alison Schut | Nurse Practitioner | 12650 W 64th Ave Ste E501, Arvada, CO 80004 | 2012-11-02 |
| 1881984102 | Green Leaf Massage Center. LLC | Health Maintenance Organization | 11890 W.64th Avenue, Arvada, CO 80004 | 2011-04-08 |
| Find all providers in zip 80004 | ||||
| Taxonomy Code | 363LA2100X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Acute Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952831661 | Lileya Sobechko | Nurse Practitioner | 7785 Carr Ct, Arvada, CO 80005-4416 | 2017-06-14 |
| 1225382906 | Alison Schut | Nurse Practitioner | 12650 W 64th Ave Ste E501, Arvada, CO 80004 | 2012-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851992176 | Misty Thomas | Nurse Practitioner | 50059 County Road 15, Wellington, CO 80549-1761 | 2020-11-03 |
| 1831799477 | Christopher Todd Hassinger | Nurse Practitioner | 3237 Osceola St, Denver, CO 80212-1741 | 2020-10-30 |
| 1225640113 | Melissa Diane Garth | Nurse Practitioner | 11912 Eudora Dr, Thornton, CO 80233-6406 | 2020-08-20 |
| 1568074672 | Arthur E Ilharreguy | Nurse Practitioner | 5565 Royal Pine St, Brighton, CO 80601-5370 | 2020-08-19 |
| 1154932481 | Leah Evans | Nurse Practitioner | 310 S Miller St, Lakewood, CO 80226-2659 | 2020-08-11 |
| 1982214136 | John Middleton Lariviere | Nurse Practitioner | 1375 Trenton St, Denver, CO 80220-3330 | 2020-08-03 |
| 1730797127 | Anne Elizabeth Kintop | Nurse Practitioner | 723 Steele St, Denver, CO 80206-3942 | 2020-07-21 |
| 1568070571 | Harrison Charles Lowell | Nurse Practitioner | 7756 S Flanders St, Centennial, CO 80016-1948 | 2020-07-15 |
| 1942824537 | Kimberly A Jones | Nurse Practitioner | 3210 N Franklin St, Denver, CO 80205-3903 | 2020-05-30 |
| 1346862893 | Camella Gullick | Nurse Practitioner | 590 Grey Squirrel Way, Franktown, CO 80116-8762 | 2020-05-07 |
| Find all providers with the same taxonomy | ||||
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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.