Individual
LAURA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
105 W STONE DR STE 1F, KINGSPORT, TN 37660-3365
(423) 230-2420
Mailing address
PO BOX 9, KINGSPORT, TN 37662-0009
(423) 857-2066
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA5304
TN
Other
Enumeration date
12/08/2022
Last updated
06/21/2024
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