KRISTINA L WAGGONER (NPI# 1770823759) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770823759 |
| Entity Type | Individual |
| Full Name | KRISTINA L WAGGONER |
| Credential | PMHNP-BC |
| Practice Address |
805 North Dickinson Drive Rusk TX 75785 |
| Practice Telephone | 9036837201 |
| Practice Fax Number | 9036837199 |
| Mailing Telephone | 9036837201 |
| Mailing Fax Number | 9036837199 |
| Enumeration Date | 2013-02-27 |
| Last Update Date | 2014-05-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
763777 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | STATE LICENSE | 763777 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225422231 | Kristina Waggoner | Clinical Nurse Specialist | 7430 Mckee Rd, Upatoi, GA 31829-1712 | 2015-03-27 |
| 1861886715 | Kristina Waggoner | Nurse Practitioner | 101 E Plummer Blvd, Chatham, IL 62629-8047 | 2015-03-27 |
| Street Address |
805 NORTH DICKINSON DRIVE |
| City | RUSK |
| State | TX |
| Zip Code | 75785 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841898137 | Pineywoods Physical Therapy LLC | Clinic/Center | 1400 West 6th Street, Suite 6 and 7, Rusk, TX 75785 | 2020-10-09 |
| 1184124943 | Deanna Adams | Nurse Practitioner | 1884 Fm343, Rusk, TX 75785 | 2018-02-19 |
| 1831584598 | Stacy Black, Dds, Pa | Dentist | 132 Hatchett, Rusk, TX 75785 | 2015-03-31 |
| 1104146257 | Rebecca Ann Vogt | Speech-Language Pathologist | 2205 East Johnson St., Rusk, TX 75785 | 2010-06-10 |
| 1710179569 | Julana Graham Schwartz | Speech-Language Pathologist | 2205 Johnson Dr., Rusk, TX 75785 | 2007-08-15 |
| 1154443844 | Alva Joy Jones | Counselor | 1400 Hwy 84 West, Cherokee Center, Suite 3, Rusk, TX 75785 | 2007-04-04 |
| 1902946916 | Stanley Self | Psychiatry & Neurology | 1601 North Dickinson Drive, Rusk, TX 75785 | 2007-02-07 |
| 1396895728 | Satyajeet Lahiri | Psychiatry & Neurology | 1601 N Dickinson Drive, Rusk, TX 75785 | 2007-01-10 |
| 1619039641 | Harry Thompson | Psychiatry & Neurology | 1601 Dickinson Drive, Rusk, TX 75785 | 2006-12-15 |
| 1063423085 | Stacy Lee Black | Dentist | 132 Hatchett St., Rusk, TX 75785 | 2006-08-11 |
| Find all providers in zip 75785 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205477510 | Lauren Nicole Main | Nurse Practitioner | 805 N Dickinson Dr, Rusk, TX 75785-1006 | 2019-10-08 |
| 1497274963 | Dana Diane Long | Nurse Practitioner | 111 Meadowlark Ln, Rusk, TX 75785-3693 | 2017-09-15 |
| 1083124572 | Sound Minds Pllc | Nurse Practitioner | 111 Meadowlark Ln, Rusk, TX 75785-3693 | 2017-10-10 |
| 1457746786 | Belinda Meharry | Nurse Practitioner | 379 Fm 2972 W, Rusk, TX 75785-3666 | 2015-04-03 |
| 1902220114 | Kristy Perry | Nurse Practitioner | 805 N. Dickinson Dr., Rusk, TX 75785 | 2014-02-07 |
| 1376882605 | Vicki Ann Moceo | Nurse Practitioner | 805 N Dickinson Drive, Rusk, TX 75785 | 2013-02-06 |
| 1568715761 | Donna Kropp | Nurse Practitioner | 805 N Dickinson Drive, Rusk, TX 75785 | 2012-10-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215537857 | Julius Abam | Nurse Practitioner | 634 Rustic Trl, Midlothian, TX 76065-2267 | 2020-10-30 |
| 1750981619 | Suvekchya Subedi | Nurse Practitioner | 4032 Vista Mar Drive, Euless, TX 76040 | 2020-10-29 |
| 1821698754 | Christienne Felice Solis Callasan | Nurse Practitioner | 1010 Palos Verdes Blvd, Arlington, TX 76017-1780 | 2020-10-29 |
| 1932709201 | Aftercare, Pllc | Nurse Practitioner | 2000 Crawford St Ste 1221, Houston, TX 77002-9000 | 2020-10-27 |
| 1497355929 | Hector Medellin IIi | Nurse Practitioner | 6014 County Road 4068, Kemp, TX 75143-2600 | 2020-10-26 |
| 1639778947 | Aj Psychiatry Pllc | Nurse Practitioner | 1920 N Coit Rd Ste 219, Richardson, TX 75080-2832 | 2020-10-19 |
| 1154929735 | Valerie Michelle Vaughn-smith | Nurse Practitioner | 3105 Rockbrook Dr, Kilgore, TX 75662-2251 | 2020-10-15 |
| 1700483468 | Knd Behavioural Health Clinic | Nurse Practitioner | 103 Herrington Dr, Mansfield, TX 76063-7615 | 2020-10-06 |
| 1184231805 | Tihana Sladic | Nurse Practitioner | 1515 S Capital of Texas Hwy Ste 300&301, Austin, TX 78746-6579 | 2020-09-27 |
| 1679189369 | Charity Chioma Durant | Nurse Practitioner | 2310 Echo Ct, Rowlett, TX 75088-1534 | 2020-09-18 |
| Find all providers with the same taxonomy | ||||
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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.