Individual
KATHRYN CLARE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
460 W 10TH AVE, COLUMBUS, OH 43210-1240
(614) 685-9483
(614) 685-0518
Mailing address
700 ACKERMAN RD STE 2120, COLUMBUS, OH 43202-1559
(614) 685-9483
(614) 685-0518
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.006912RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0453033
—
OH
Enumeration date
06/02/2021
Last updated
08/09/2021
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