# KATHLEEN T. WAGNER, MD, PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Pioneer Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932379344
- **Authorized official:** DR. KATHLEEN T. WAGNER M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (702) 364-9988

## Contact information

- **Practice address:** 3120 S RAINBOW BLVD, SUITE 202, LAS VEGAS, NV 89146-6236
- **Practice address phone:** (702) 364-9988
- **Practice address fax:** (702) 364-0880
- **Mailing address:** PO BOX 81348, LAS VEGAS, NV 89180-1348
- **Mailing address phone:** (702) 364-9988
- **Mailing address fax:** (702) 364-0880

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 9669 | NV | Yes |

## Other

- **Enumeration date:** 03/03/2008
- **Last updated:** 03/03/2008