Dr. Jessie Wagner, DO
Family Medicine in Kansas City, KS. Individual provider (NPI-1).
NPI number1619729068
StatusActive
Last updated in NPPESJun 13, 2024
Details
- NPI
- 1619729068
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jessie Wagner
- Credential
- DO
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 1, 2024
- Certification date
- Jun 13, 2024
- Last updated
- Jun 13, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 94-11789 | KS | Yes |
Practice location
3901 Rainbow Blvd, Mailstop 4034Kansas City, KS 66160
Phone 913-588-1908
Mailing address
3901 Rainbow Blvd, Mailstop 4034Kansas City, KS 66160
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