Provider Demographics
NPI:1760713432
Name:WAGNER KLEPPINGER, WENDI SUZANNE (PHD, PA-C)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:SUZANNE
Last Name:WAGNER KLEPPINGER
Suffix:
Gender:F
Credentials:PHD, PA-C
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Other - First Name:
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Mailing Address - Street 1:3201 S AUSTIN AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7639
Mailing Address - Country:US
Mailing Address - Phone:512-763-4000
Mailing Address - Fax:512-930-1259
Practice Address - Street 1:3201 S AUSTIN AVE STE 210
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7639
Practice Address - Country:US
Practice Address - Phone:512-763-4000
Practice Address - Fax:512-930-4946
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2014-01-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX288015501Medicaid
TX288015501Medicaid