Individual
KIMBERLY D WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3071 S GRAND AVE, CARTHAGE, MO 64836-7851
(417) 358-4811
(417) 358-4781
Mailing address
3071 S GRAND AVE, CARTHAGE, MO 64836-7851
(417) 358-4811
(417) 358-4781
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2004003094
MO
Other
Enumeration date
03/22/2007
Last updated
09/04/2009
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