Individual
KEITH WILLIAM WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BSN, RN-BC
Contact information
Practice address
110 N STATE HIGHWAY 274, KEMP, TX 75143-4617
(430) 255-2199
Mailing address
105 ARAPAHO TRL, MABANK, TX 75156-9176
(903) 603-3979
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
Primary
919371
TX
Other
Enumeration date
09/20/2024
Last updated
09/20/2024
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