Provider Demographics
NPI:1396223608
Name:WAGGONER, KRISTEN NICOLE (AUD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:NICOLE
Last Name:WAGGONER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8109 BEAVER RIDGE ROAD
Mailing Address - Street 2:KARNS ANNEX BUILDING A
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931
Mailing Address - Country:US
Mailing Address - Phone:865-539-3045
Mailing Address - Fax:865-539-3039
Practice Address - Street 1:8109 BEAVER RIDGE ROAD
Practice Address - Street 2:KARNS ANNEX BUILDING A
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931
Practice Address - Country:US
Practice Address - Phone:865-539-3045
Practice Address - Fax:865-539-3039
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1836231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist