DERRICK C WAGNER (NPI# 1952685125) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952685125 |
| Entity Type | Individual |
| Full Name | DERRICK C WAGNER |
| Credential | FNP-C |
| Practice Address |
3002 Sam Houston Dr Victoria TX 77904-2682 |
| Mailing Address |
308 S De Leon St Victoria TX 77901-8288 |
| Practice Telephone | 3615785730 |
| Mailing Telephone | 3616765519 |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2011-10-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
737124 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3002 SAM HOUSTON DR |
| City | VICTORIA |
| State | TX |
| Zip Code | 77904-2682 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750367314 | Jean Gisler | Nurse Practitioner | 3002 Sam Houston Dr, Victoria, TX 77904-2682 | 2005-12-15 |
| 1265826713 | Sarah Elizabeth Lewis | Nurse Practitioner | 3002 Sam Houston Dr, Victoria, TX 77904-2682 | 2015-03-23 |
| 1144634197 | Tina Hendrick | Nurse Practitioner | 3002 Sam Houston Dr, Victoria, TX 77904-2682 | 2014-06-18 |
| 1922373539 | Debra A Mcdaniel | Nurse Practitioner | 3002 Sam Houston Dr, Victoria, TX 77904-2682 | 2012-03-14 |
| 1598078453 | Twin Fountains Urgent Care Center | Internal Medicine | 3002 Sam Houston Dr, Victoria, TX 77904-2682 | 2010-07-21 |
| 1225153414 | Theresa Renee Rodriguez | Physician Assistant | 3002 Sam Houston Dr, Victoria, TX 77904-2682 | 2007-03-20 |
| 1942332812 | Desiree Young Moore | Nurse Practitioner | 3002 Sam Houston Dr, Victoria, TX 77904-2682 | 2007-03-09 |
| 1205812898 | John Lee Mcneill | Emergency Medicine | 3002 Sam Houston Dr, Victoria, TX 77904-2682 | 2005-12-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528600384 | Bertha P Mendieta | Physician Assistant | Citizens Victoria Surgical Associates, 2705 Hospital Drive Suite 400, Building B, Victoria, TX 77904 | 2019-10-14 |
| 1952968901 | Eliza Welder | Counselor | 6502 Nursery Dr. Suite, Suite 100, Victoria, TX 77904 | 2019-05-24 |
| 1154806529 | Tammy Lynn Hogan | Counselor | 4702 N. Laurent Ste D, Victoria, TX 77904 | 2018-10-01 |
| 1740724939 | Sarah Ritchea | Counselor | 6502 Nursery Dr. Suite 100, Victoria, TX 77904 | 2016-12-07 |
| 1992177489 | World of Words Speech & Feeding Services, LLC | Speech-Language Pathologist | 120 Appaloosa Dr., Victoria, TX 77904 | 2015-10-23 |
| 1396115739 | Katelin Mcvey | Physician Assistant | 106 Springwood Drive, Suite 100, Victoria, TX 77904 | 2015-09-28 |
| 1689070062 | Jeremy M Thompson Dds Ms Pllc | Clinic/Center | 103 Professional Park Driv, Victoria, TX 77904 | 2014-11-12 |
| 1265864144 | Pf Development 23, LLC | Hospice Care, Community Based | 1501 E Mockingbird Ln Ste 301b, Victoria, TX 77904 | 2013-08-02 |
| 1053669762 | Victoria Dentistry, Pllc | Dentist | 8809 North Navarro, Ste.100, Victoria, TX 77904 | 2012-08-28 |
| 1508126442 | Ayo Adu, M.d., Pllc | Family Medicine | 9410 Ne Zac Lentz Parkway, Suite 200, Victoria, TX 77904 | 2012-05-25 |
| Find all providers in zip 77904 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366098915 | Zachary Barber | Nurse Practitioner | 605 E San Antonio St # 509, Victoria, TX 77901-6050 | 2019-08-09 |
| 1396304390 | Olanrewaju Omobola Olurode | Nurse Practitioner | 104 Buckskin Trl, Victoria, TX 77904-2962 | 2019-06-12 |
| 1780169946 | Kelli Longoria | Nurse Practitioner | 2700 Citizens Plz Ste 400, Victoria, TX 77901-5757 | 2018-10-03 |
| 1497238869 | Crystal Joan Douglas | Nurse Practitioner | 9006 N Navarro St, Victoria, TX 77904-1565 | 2018-09-12 |
| 1790270106 | Jeremiah E Bast | Nurse Practitioner | 605 E San Antonio St Ste 509e, Victoria, TX 77901-6079 | 2018-06-27 |
| 1811488349 | Victoria Np Clinic Pllc | Nurse Practitioner | 606 E. Nueces St, Victoria, TX 77901 | 2018-05-21 |
| 1578913323 | Acadia Matilda Joines | Nurse Practitioner | 104 Watermark, Victoria, TX 77904-1168 | 2016-06-13 |
| 1518337690 | Nikki Reger | Nurse Practitioner | 102 Andrew Dr, Victoria, TX 77904-2938 | 2015-10-01 |
| 1336524974 | Adan Hinojosa Adame | Nurse Practitioner | 102 Contento St, Victoria, TX 77905-0688 | 2015-07-24 |
| 1235522509 | Kristi Williams | Nurse Practitioner | 728 Menke Rd, Victoria, TX 77905-5757 | 2015-03-11 |
| Find all providers in VICTORIA | ||||
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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.