Individual
ERIN ELIZABETH WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3810 SPRINGHURST BLVD STE 200, LOUISVILLE, KY 40241-6162
(502) 583-1749
Mailing address
3810 SPRINGHURST BLVD STE 200, LOUISVILLE, KY 40241-6162
(502) 583-1749
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TC092
KY
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
07/08/2021
Last updated
09/08/2021
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