Individual
KELSEY LEIGH WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
214 E 23RD ST, CHEYENNE, WY 82001-3748
(307) 634-2273
Mailing address
214 E 23RD ST, CHEYENNE, WY 82001-3748
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PT774
WY
Other
Enumeration date
07/31/2018
Last updated
07/31/2018
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