Provider Demographics
NPI:1043311632
Name:WAGONER, KARLEE CRUMPTON (APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:KARLEE
Middle Name:CRUMPTON
Last Name:WAGONER
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5821 FARRINGTON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-9901
Mailing Address - Country:US
Mailing Address - Phone:919-403-6200
Mailing Address - Fax:919-403-6242
Practice Address - Street 1:5821 FARRINGTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-9901
Practice Address - Country:US
Practice Address - Phone:919-403-6200
Practice Address - Fax:919-403-6242
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005001621363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0235HOtherBCBS
NC4420282OtherAETNA
NC0050-01621OtherLICENSE NUMBER
NC0050-01621OtherLICENSE NUMBER
NC2325006Medicare ID - Type Unspecified