# BLAIR KELLY WAGNER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1518509777
- **Gender:** F
- **Credential:** DNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 173292 | MT | — |
| 363L00000X | Nurse Practitioner | 3013869 | KY | Yes |
| 363LN0000X | Neonatal Nurse Practitioner | 3013869 | KY | — |

## Other

- **Enumeration date:** 10/09/2019
- **Last updated:** 02/18/2021