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Individual
CRYSTAL WAGNER
Active
Individual
CRYSTAL WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3009831
KY
363L00000X
Nurse Practitioner
71010822A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0229162
—
OH
05
—
7100411630
—
KY
Enumeration date
12/10/2015
Last updated
06/26/2025
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