Organization
KENDALL D. WAGNER, M.D., PLLC
Active
Other names
Chaffee Crossing Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENDALL DARREN WAGNER MD (PHYSICIAN)
(501) 766-6311
Entity
Organization
Contact information
Practice address
11300 ROBERTS BLVD, FORT SMITH, AR 72916-6027
(000) 000-0000
Mailing address
8331 HOWARD HILL RD, FORT SMITH, AR 72916-9787
(501) 766-6311
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202855001
—
AR
Enumeration date
10/20/2021
Last updated
10/20/2021
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