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Individual

CRYSTAL WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
85 N GRAND AVE, FORT THOMAS, KY 41075-1793
(859) 572-3617
(859) 572-2326
Mailing address
PO BOX 18667, ERLANGER, KY 41018-0667
(513) 312-2247
(859) 572-2326

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3009831
KY
363L00000X
Nurse Practitioner
71010822A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0229162
OH
05
7100411630
KY
Enumeration date
12/10/2015
Last updated
06/26/2025
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