Individual
ASHLEY CHRISTINE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3724 EXECUTIVE CENTER DR STE G10, AUSTIN, TX 78731-1665
(512) 324-9720
Mailing address
428 LEWISVILLE LN, LEANDER, TX 78641-4046
(361) 500-2803
Taxonomy
Speciality
Code
Description
License number
State
2083S0010X
Sports Medicine (Preventive Medicine) Physician
Primary
AT5055
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000007383
BOARD OF CERTIFICATION
—
01
—
AT5055
STATE OF TEXAS LICENSURE
TX
Enumeration date
02/18/2019
Last updated
02/18/2019
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