MS. KIMBER TRACY VAN WAGONER (NPI# 1801866512) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1801866512 |
Entity Type | Individual |
Full Name | MS. KIMBER TRACY VAN WAGONER |
Other Name | MS. KYMBER TRACY VAN WAGONER |
Credential | B.A., R.N. |
Practice Address |
1020 S Main St Salt Lake City UT 84101-3176 |
Mailing Address |
1134 E 2700 S D 26 Salt Lake City UT 84106-2642 |
Practice Telephone | 8015397000 |
Practice Fax Number | 8015397050 |
Mailing Telephone | 8014864104 |
Enumeration Date | 2006-01-25 |
Last Update Date | 2007-07-08 |
Gender Code | F |
Is Sole Proprietor | X |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 163WP0809X |
Registered Nurse Specialization: Psych/Mental Health, Adult |
03081433102 | UT | Nursing Service Providers |
Street Address |
1020 S MAIN ST |
City | SALT LAKE CITY |
State | UT |
Zip Code | 84101-3176 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1659355790 | James D. Ricciardi | Psychologist | 1020 S Main St, Salt Lake City, UT 84101-3176 | 2005-12-02 |
1861958506 | Pamrose Sitake | Registered Nurse | 1020 S Main St, Salt Lake City, UT 84101-3176 | 2019-02-19 |
1821562760 | Christopher Davis | Pharmacy Technician | 1020 S Main St, Salt Lake City, UT 84101-3176 | 2019-01-14 |
1346713732 | Eric Sitta | Community Health Worker | 1020 S Main St, Salt Lake City, UT 84101-3176 | 2019-01-08 |
1215405048 | Mackenzie Heather Blundell | Case Manager/Care Coordinator | 1020 S Main St, Salt Lake City, UT 84101-3176 | 2018-11-09 |
1588132724 | Natalie Jeanine Williams | Community Health Worker | 1020 S Main St, Salt Lake City, UT 84101-3176 | 2018-11-06 |
1609343482 | Sophia Renee Felix | Community Health Worker | 1020 S Main St, Salt Lake City, UT 84101-3176 | 2018-10-30 |
1437630431 | Mark J Sanchez | Behavioral Analyst | 1020 S Main St, Salt Lake City, UT 84101-3176 | 2018-08-27 |
1174004196 | Kristin Emily Olsen | Behavioral Analyst | 1020 S Main St, Salt Lake City, UT 84101-3176 | 2018-08-27 |
1912488990 | Zachary Staton Tucker | Behavioral Analyst | 1020 S Main St, Salt Lake City, UT 84101-3176 | 2018-08-27 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1053804237 | Holly Smith | Registered Nurse | 1020 S Main Street, Salt Lake City, UT 84101 | 2018-06-12 |
1174999627 | Justin Williams | Social Worker | 155 W. 300 S., Salt Lake City, UT 84101 | 2015-08-19 |
1902291842 | Daryl Ray Ezidore | Student in an Organized Health Care Education/Training Program | 100 South 344 East, Salt Lake City, UT 84101 | 2015-03-30 |
1104190859 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 50 S Main St Ste 115, Salt Lake City, UT 84101 | 2012-02-28 |
1366713307 | Gonstead Family Chiropractic | Chiropractor | 1154 S. 300 W., Suite C, Salt Lake City, UT 84101 | 2012-01-23 |
1659544880 | Jeffrey Daniel | Registered Nurse | 404 South 400 West, Salt Lake City, UT 84101 | 2008-04-09 |
1306030580 | Christopher Dean Chapman | Chiropractor | 345 W 100 S Ste 6c, Salt Lake City, UT 84101 | 2007-08-30 |
1689713497 | Walter Landon Bye | Dentist | 15 West South Temple, Gateway Tower West Suite 440, Salt Lake City, UT 84101 | 2007-02-06 |
1154403152 | Allison Miller Gardner | Physical Therapist | 84 West 700 South, Salt Lake City, UT 84101 | 2006-10-19 |
1780655407 | Frederick Van Der Veur | Social Worker | 1020 South Main Street, 242, Salt Lake City, UT 84101 | 2006-01-30 |
Find all providers in zip 84101 |
Taxonomy Code | 163WP0809X |
Grouping | Nursing Service Providers |
Classification | Registered Nurse |
Specialization | Psych/Mental Health, Adult |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1124048319 | Stella Blight | Registered Nurse | 500 S. Foothill Blvd, George Wahlen Vamc, Salt Lake City, UT 84109 | 2006-07-20 |
1629003900 | Helen L Stanhope | Registered Nurse | 1399 South 700 Easrt, Suite 17b, Salt Lake City, UT 84105 | 2006-07-12 |
1790727733 | Lisa Ann Jensen | Registered Nurse | Slc Va Health Care System, 500 Foothill Blvd, Salt Lake City, UT 84148-0001 | 2006-06-12 |
1619955812 | John Richard Mitchell | Registered Nurse | 5965 South 900 East, Ste 240 Valley Mental Health Ad, Salt Lake City, UT 84121-1720 | 2006-01-06 |
1568449619 | Sue Ellen Fisher | Registered Nurse | 2994 Tolcate Ln, Salt Lake City, UT 84121-1529 | 2005-12-29 |
1497745301 | Debra Lynn Falvo | Registered Nurse | 5965 S 900 E, Salt Lake City, UT 84121-1720 | 2005-10-24 |
1043835630 | Cynthia Garbett | Registered Nurse | 265 E 100 S Ste 250, Salt Lake City, UT 84111-1643 | 2020-06-10 |
1700121332 | Christian Michael Judd | Registered Nurse | 4460 S Highland Dr Ste 210, Salt Lake City, UT 84124 | 2012-12-08 |
1538350749 | Samuel B Vincent | Registered Nurse | 404 S 400 W, Salt Lake City, UT 84101-2201 | 2007-08-05 |
1700908159 | Rebecca Clough | Registered Nurse | 500 Foothill Blvd, Salt Lake City, UT 84148-0001 | 2007-04-05 |
Find all providers in SALT LAKE CITY |
City | SALT LAKE CITY |
Zip Code | 84101 |
Please comment or provide details below to improve the information on MS. KIMBER TRACY VAN WAGONER.
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.