Individual
MICHAEL SCOTT WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PRSS
Contact information
Practice address
1218 5TH AVE, HUNTINGTON, WV 25701-2234
(681) 378-3908
Mailing address
207 NEDRA DR, BARBOURSVILLE, WV 25504-1141
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
WV
175T00000X
Peer Specialist
Primary
23-9241
WV
Other
Enumeration date
11/08/2023
Last updated
04/28/2026
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