DR. WILLIAM ROBERT WAGNER DRNP LCSW NPI 1043219587

NPI Information

NPI: 1043219587
Provider Name: DR. WILLIAM ROBERT WAGNER, DRNP, LCSW
Classification: Nurse Practitioner - 363LA2200X
Entity Type: Individual

Specialization: Adult Health

PECOS Registration: Yes

Address:
1000 HEALTH CENTER ROAD
KYLE HEALTH CENTER / DHHS/IHS
KYLE, SD
ZIP 57752
Phone: (917) 626-9011
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DR. William Robert Wagner, DRNP, LCSW is an adult health nurse practitioner in Kyle, SD. DR. William Robert Wagner, DRNP, LCSW NPI is 1043219587. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1000 HEALTH CENTER ROAD
KYLE HEALTH CENTER / DHHS/IHS
KYLE, SD
ZIP 57752
Phone: (917) 626-9011

The NPI 1043219587 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/18/2005 and was last updated on 4/29/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1041C0700X	Social Worker	Clinical	R055430	NEW YORK	No
2	163W00000X	Registered Nurse		541137	NEW YORK	No
3	363LG0600X	Nurse Practitioner	Gerontology	F340615	NEW YORK	No
4	363LA2200X	Nurse Practitioner	Adult Health	F304782	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	Q59896	MEDICARE UPIN
2	S966N122	MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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