Individual
MILES WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AGACNP-BC
Contact information
Practice address
2124 14TH ST, MERIDIAN, MS 39301-4040
(601) 553-6000
Mailing address
340 LONGWOOD DR, MERIDIAN, MS 39305-8231
(601) 678-3854
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
906964
MS
363LG0600X
Gerontology Nurse Practitioner
906964
MS
Other
Enumeration date
01/19/2023
Last updated
05/06/2025
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