Individual
BETHANY GALE WAGENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2901 N CLASSEN BLVD, SUITE 200, OKLAHOMA CITY, OK 73106-5493
(918) 594-1300
(918) 594-1312
Mailing address
9014 W ROGERS BLVD, SKIATOOK, OK 74070-5528
(405) 408-3547
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
APA2006
OK
Other
Enumeration date
03/15/2011
Last updated
03/15/2011
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