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Individual

KEVIN WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
FNP

Contact information

Practice address
1001 BLYTHE BLVD, STE 300- ADULT CARDIOLOGY, CHARLOTTE, NC 28203-5866
(704) 373-0212
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2021021010
MO
363L00000X
Nurse Practitioner
204420
OK
363L00000X
Nurse Practitioner
Primary
5012830
NC

Other

Enumeration date
02/11/2020
Last updated
04/17/2024
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