Individual
GABRIELLE KYRA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
(304) 388-5432
Mailing address
36 OVERLOOK DR, BRIDGEPORT, WV 26330-1022
(304) 677-0114
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
WV
Other
Enumeration date
04/10/2026
Last updated
04/10/2026
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