Individual
SHELBY YOUNG WAGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
619 S FLEISHEL AVE, STE 327, TYLER, TX 75701-2004
(903) 510-1173
(903) 525-1312
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT83604
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
348718301
—
TX
05
—
348718302
—
TX
01
—
75-0818167-015
TRICARE
TX
01
—
75-2616977-124
TRICARE
TX
01
—
8FA580
BCBS
TX
01
—
8FA581
BCBS
TX
01
—
P01464094
RAIL ROAD MEDICARE
TX
01
—
P01464110
RAIL ROAD MEDICARE
TX
Enumeration date
03/26/2015
Last updated
12/28/2015
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