Provider Demographics
NPI:1881223832
Name:WAGNON, ASHER
Entity Type:Individual
Prefix:
First Name:ASHER
Middle Name:
Last Name:WAGNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 HOLMES RD STE 450
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1173
Mailing Address - Country:US
Mailing Address - Phone:816-995-3070
Mailing Address - Fax:816-276-7090
Practice Address - Street 1:6675 HOLMES RD STE 450
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1173
Practice Address - Country:US
Practice Address - Phone:816-995-3070
Practice Address - Fax:816-276-7090
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-16989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine