DR. KATHRYNE A WAGNER (NPI# 1740261817) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740261817 |
| Entity Type | Individual |
| Full Name | DR. KATHRYNE A WAGNER |
| Credential | MD |
| Practice Address |
500 Lilly Rd Ne Suite 204 Olympia WA 98506-5195 |
| Mailing Address |
209 Lilly Rd Ne Olympia WA 98506 |
| Practice Telephone | 3604138250 |
| Practice Fax Number | 3604138830 |
| Mailing Telephone | 3604138250 |
| Mailing Fax Number | 3604138830 |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2020-10-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
MD00029477 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | DEA NUMBER | BW3122392 | 01 |
| WA | MD LICENSE | MD00029477 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 209 Lilly Rd Ne, Olympia, WA 98506 | 3604138250 | 3604138830 |
| Street Address |
500 LILLY RD NE SUITE 204 |
| City | OLYMPIA |
| State | WA |
| Zip Code | 98506-5195 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871594325 | David H Schoening | Internal Medicine | 500 Lilly Rd Ne, Ste 100, Olympia, WA 98506 | 2005-08-09 |
| 1720644073 | Carol Neff Moreno | Family Medicine | 500 Lilly Rd Ne, Olympia, WA 98506-5195 | 2019-05-13 |
| 1770936015 | Ester Monique Brown | Licensed Practical Nurse | 500 Lilly Rd Ne, Olympia, WA 98506-5195 | 2016-07-22 |
| 1073969101 | Samantha Moore | Physician Assistant | 500 Lilly Rd Ne, Olympia, WA 98506-5195 | 2016-05-07 |
| 1467720292 | Sarah Byram Poppe | Nurse Practitioner | 500 Lilly Rd Ne, Suite 204, Olympia, WA 98506-5197 | 2011-12-07 |
| 1164724308 | Providence Health & Services-washington | Internal Medicine | 500 Lilly Rd Ne, Suite 100, Olympia, WA 98506-5195 | 2010-11-20 |
| 1659554624 | Scott David Werden | Internal Medicine | 500 Lilly Rd Ne, Memorial Medical Plaza, Olympia, WA 98506-5195 | 2007-12-12 |
| 1124144431 | Elijah Telfare | Physician Assistant | 500 Lilly Rd Ne, Suite 100, Olympia, WA 98506-5195 | 2007-03-21 |
| 1194867887 | Northwest Radiology Group LLC | Specialist | 500 Lilly Rd Ne, Suite 160, Olympia, WA 98506-5195 | 2007-02-12 |
| 1245391390 | Patrick C Williams | Physician Assistant | 500 Lilly Rd Ne, Suite 204, Olympia, WA 98506-5197 | 2006-12-13 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477185460 | Chloe Harper | Technician, Other | 3443 Lilly Rd Se, Ste B, Olympia, WA 98506 | 2020-02-07 |
| 1912543539 | Jessica Marie Radakovich | Licensed Practical Nurse | 3426 Mary Elder Rd, Olympia, WA 98506 | 2019-11-19 |
| 1669014973 | Arlene Josephine Adams | Registered Nurse | 413 Lily Rd Ne, Olympia, WA 98506 | 2019-10-09 |
| 1861999120 | Debra Delores Barker | Licensed Practical Nurse | 3710 South Bay Rd Ne, Olympia, WA 98506 | 2018-04-12 |
| 1801304431 | Michelle Warner | Nurse Practitioner | 205 Lilly Rd Ne Ste A1, Olympia, WA 98506 | 2018-01-17 |
| 1396258364 | Institute for Family Development | Community/Behavioral Health | 204 Quince St. Ne, Suite 200, Olympia, WA 98506 | 2017-11-13 |
| 1083137715 | Cameron Kunkel | Specialist/Technologist | 2512 20th Ave Ne, Olympia, WA 98506 | 2017-07-25 |
| 1184144768 | Trevor Shane Kwan | Family Medicine | 525 Lilly Road Ne, Olympia, WA 98506 | 2017-06-23 |
| 1073043212 | Michael H Harburg | Behavior Technician | 3857 Martin Way Ne, Olympia, WA 98506 | 2017-06-19 |
| 1780114371 | Priscilla Kangyang Jadu | Counselor | 3857 Martin Way E., Olympia, WA 98506 | 2017-06-15 |
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| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841301090 | Kristine Y Zhang | Internal Medicine | 500 Lilly Rd Ne # 204, Olympia, WA 98506 | 2006-08-31 |
| 1558342501 | Rodney W Joe | Internal Medicine | 500 Lilly Rd Ne Ste 204, Olympia, WA 98506-5197 | 2005-11-08 |
| 1831191162 | Marshall Edward Mccabe IIi | Internal Medicine | 406 Black Hills Ln Sw, Ste A, Olympia, WA 98502-8144 | 2005-05-31 |
| 1144379918 | Meimin Xie | Internal Medicine | 500 Lilly Rd Ne Ste 204, Olympia, WA 98506-5197 | 2007-01-09 |
| 1144302159 | David Justin Owens | Internal Medicine | 500 Lilly Rd Ne Ste 204, Olympia, WA 98506-5197 | 2006-10-19 |
| 1437102167 | Gastroenterology Associates, Pllc | Internal Medicine | 500 Lilly Rd Ne, #204, Olympia, WA 98506-5195 | 2006-05-17 |
| 1497736573 | James F Kruidenier | Internal Medicine | 500 Lilly Rd Ne, Suite 204, Olympia, WA 98506-5195 | 2005-11-07 |
| 1083695167 | Benjamin F Merrifield | Internal Medicine | 500 Lilly Rd Ne, Suite 204, Olympia, WA 98506-5195 | 2005-11-07 |
| 1528058658 | Harpreet S Brar | Internal Medicine | 500 Lilly Rd Ne, Olympia, WA 98506-5195 | 2005-10-28 |
| 1912998048 | Bruce A Silverman | Internal Medicine | 500 Lilly Rd Ne, Suite 204, Olympia, WA 98506-5195 | 2005-10-28 |
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| 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.