Individual
KRISTINA L WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
805 NORTH DICKINSON DRIVE, RUSK, TX 75785
(903) 683-7201
(903) 683-7199
Mailing address
805 NORTH DICKINSON DRIVE, RUSK, TX 75785
(903) 683-7201
(903) 683-7199
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
763777
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
763777
STATE LICENSE
TX
Enumeration date
02/27/2013
Last updated
05/19/2014
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