Individual
REBECCA S WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
703 S FLEISHEL AVE STE 5000, TYLER, TX 75701-2015
(903) 606-6139
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 606-6400
(903) 606-1522
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN60123376
WA
363L00000X
Nurse Practitioner
Primary
1004878
TX
363LA2100X
Acute Care Nurse Practitioner
AP60542393
WA
Other
Enumeration date
02/23/2015
Last updated
06/17/2025
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