TERESA L WAGNER (NPI# 1275096364) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275096364 |
| Entity Type | Individual |
| Full Name | TERESA L WAGNER |
| Credential | DRPH, MS, CPH, RD/LD |
| Practice Address |
5841 Recreation Dr Apt 2404 Fort Worth TX 76109-1068 |
| Mailing Address |
855 Montgomery St Fort Worth TX 76107-2553 |
| Practice Telephone | 8178051252 |
| Mailing Telephone | 8177350387 |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2019-04-30 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133V00000X | Dietitian, Registered | DT02954 | TX | Dietary & Nutritional Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | CERTIFIED COMMUNITY HEALTH WORKER INSTRUCTOR | 393 | 01 |
| REGISTERED DIETITIAN | 709400 | 01 | |
| NATIONAL BOARD OF PUBLIC HEALTH EXAMINERS | 10551 | 01 | |
| TX | LICENSED DIETITIAN | DT02954 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306212022 | Teresa Wagner | Licensed Practical Nurse | 131 E Columbia Ave., Suite 115, Battle Creek, MI 49015 | 2015-08-17 |
| 1336271477 | Teresa Lee Wagner | Social Worker | 215 N Geneva St, Ithaca, NY 14850-4135 | 2007-03-12 |
| 1033215181 | Teresa Wagner | Internal Medicine | 1560 N 115th St Ste G10, Seattle, WA 98133-8414 | 2006-09-16 |
| 1114484714 | Teresa Wagner | Assisted Living Facility | 1341 Rosebud Ln, Billings, MT 59101-6527 | 2019-03-01 |
| 1770969750 | Teresa Wagner | Dietitian, Registered | 45 Snelling Ave N, Saint Paul, MN 55104-6842 | 2015-08-03 |
| 1255663605 | Teresa J. Wagner | Case Manager/Care Coordinator | 801 Park Ave, Minneapolis, MN 55404-1136 | 2010-02-10 |
| 1184744955 | Teresa A Wagner | Counselor | 65-1206 Mamalahoa Hwy, Kamuela, HI 96743-7303 | 2007-03-29 |
| 1255487286 | Teresa Michelle Wagner | Physical Therapist | 807 N Tyndall Pkwy, Panama City, FL 32404-9495 | 2007-01-25 |
| 1063572717 | Teresa Moore Wagner | Registered Nurse | 150 Duncan Road, Buckeye, WV 24924-9037 | 2006-12-11 |
| Street Address |
5841 RECREATION DR APT 2404 |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76109-1068 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881156164 | Elizabeth Laborde Dds Pllc | Clinic/Center | 5656 Edwards Ranch Rd, Fort Worth, TX 76109 | 2019-04-04 |
| 1992273965 | Debra Cooper Lantz | Occupational Therapist | 4252 Bryant Irvin Road, Fort Worth, TX 76109 | 2018-11-08 |
| 1417434119 | Dermatology Specialists of Fort Worth Pllc | Dermatology | 6100 Southwest Blvd., Suite 100, Fort Worth, TX 76109 | 2018-07-25 |
| 1417446709 | Eating Recovery Center of Texas, LLC | Clinic/Center | 4200 S. Hulen Street, Suite #436, Ft. Worth, TX 76109 | 2018-05-02 |
| 1245751742 | Marissa Izabel San Miguel | Optometrist | 5912 Convair Dr Ste 208, Fort Worth, TX 76109 | 2017-07-05 |
| 1174910111 | Parkway Dental Professionals | Preferred Provider Organization | 4200 Bryant Irvin Rd. Ste. 101, Fort Worth, TX 76109 | 2015-04-16 |
| 1831583095 | Deborah K Lehmann, M.d. | Clinic/Center | 6420 Southwest Blvd., #128, Fort Worth, TX 76109 | 2015-03-26 |
| 1184036428 | Ft Worth Ranch Assist, LLC | Neurological Surgery | 3516 Ranch View Terrace, Fort Worth, TX 76109 | 2014-05-21 |
| 1821435538 | Metx LLC | Hearing Instrument Specialist | 4618 Sw Loop 820, Fort Worth, TX 76109 | 2013-06-04 |
| 1356608087 | Virginia Flores | Social Worker | 4208 Ranier Ct, Fort Worth, TX 76109 | 2012-04-19 |
| Find all providers in zip 76109 | ||||
| Taxonomy Code | 133V00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568076396 | Paige M Freeman | Dietitian, Registered | 150 Boland St Apt 409, Fort Worth, TX 76107-1214 | 2020-08-31 |
| 1891321220 | Petra P Rack | Dietitian, Registered | 2601 S University Dr, Fort Worth, TX 76109-1149 | 2020-03-17 |
| 1043865751 | Ngoc Anh Thu Ho | Dietitian, Registered | 2200 W Lowden St Apt 15, Fort Worth, TX 76110-2810 | 2019-08-08 |
| 1346808698 | Baillie Adrian Troskot | Dietitian, Registered | 1401 Ballinger St, Fort Worth, TX 76102-5903 | 2019-06-02 |
| 1316403595 | Gregory Michael Carr Jr. | Dietitian, Registered | 5000 Cobham Way Apt 325, Fort Worth, TX 76132-6204 | 2019-02-13 |
| 1285131250 | Kaitlin Legler | Dietitian, Registered | 9637 Rosina Trl, Fort Worth, TX 76126-2245 | 2018-04-06 |
| 1295235356 | Meghan Elise Martinson | Dietitian, Registered | 653 Bareback Ln, Fort Worth, TX 76131-3121 | 2018-02-15 |
| 1124547955 | Allie Jo Taschuk | Dietitian, Registered | 2201 Se Loop 820 Rm 2n-121, Fort Worth, TX 76119-5863 | 2017-09-13 |
| 1790207165 | Vanessa Abbood | Dietitian, Registered | 900 Eighth Ave, Fns Department, Fort Worth, TX 76104 | 2017-07-07 |
| 1124554563 | Klacie Norris | Dietitian, Registered | 801 W Shaw St, Apt 306, Fort Worth, TX 76110-4075 | 2017-05-04 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76109 |
Please comment or provide details below to improve the information on TERESA L WAGNER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.