Individual
STACY L WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1305 E 19TH AVE, WINFIELD, KS 67156-5201
(620) 221-9500
(620) 221-3700
Mailing address
1305 E 19TH AVE, WINFIELD, KS 67156-5201
(620) 221-9500
(620) 221-3700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
15-01553
—
363AM0700X
Medical Physician Assistant
Primary
15-01553
KS
Other
Enumeration date
08/30/2012
Last updated
06/12/2024
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