Individual
KRYSTN RAE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3601 THE VANDERBILT CLINIC, NASHVILLE, TN 37232-3733
(615) 322-3000
Mailing address
3841 GREEN HILLS VILLAGE DR, NASHVILLE, TN 37215-2691
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
040631
CT
207R00000X
Internal Medicine Physician
88761
GA
207RI0200X
Infectious Disease Physician
040631
CT
207RI0200X
Infectious Disease Physician
Primary
69119
TN
208M00000X
Hospitalist Physician
040631
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001406314
—
CT
Enumeration date
11/29/2005
Last updated
10/26/2023
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