Individual
TYLER WAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HIS
Contact information
Practice address
425 ASHLEY RIDGE BLVD, SHREVEPORT, LA 71106-7226
(318) 797-3311
Mailing address
494 OCKLEY DR, SHREVEPORT, LA 71105-2920
(318) 840-6414
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
1268
LA
Other
Enumeration date
02/28/2019
Last updated
02/28/2019
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