Provider Demographics
NPI:1811375173
Name:WAGNER, JENNIFER KLINE (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KLINE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:836 E 65TH STREET
Mailing Address - Street 2:SUITE 22
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-819-7878
Mailing Address - Fax:912-819-3320
Practice Address - Street 1:5353 REYNOLDS STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-355-5755
Practice Address - Fax:912-355-5759
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2021-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN168411363L00000X
GA168411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner