Individual
JERED WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
UK SURGERY CLINIC - CARDIOTHORACIC, 740 S LIMESTONE STE L304, LEXINGTON, KY 40536
(859) 323-6494
Mailing address
740 S LIMESTONE THIRD FLOOR ROOM L300, LEXINGTON, KY 40536-0001
(859) 323-6494
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TC030
KY
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
TC030
KY
363AS0400X
Surgical Physician Assistant
TC030
KY
Other
Enumeration date
06/22/2020
Last updated
05/31/2022
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