Provider Demographics
NPI:1710437413
Name:WAGGONER, ROYA (APRN)
Entity Type:Individual
Prefix:
First Name:ROYA
Middle Name:
Last Name:WAGGONER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ROJA
Other - Middle Name:K
Other - Last Name:TAGHIZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 741331
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1331
Mailing Address - Country:US
Mailing Address - Phone:913-428-1500
Mailing Address - Fax:913-428-1500
Practice Address - Street 1:10600 MASTIN ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-5723
Practice Address - Country:US
Practice Address - Phone:913-469-6447
Practice Address - Fax:913-338-1311
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77422363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner