Provider Demographics
NPI:1881227478
Name:WAGGY, KAREN T
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:T
Last Name:WAGGY
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 1:5415 SUMMERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-8802
Mailing Address - Country:US
Mailing Address - Phone:254-718-4843
Mailing Address - Fax:
Practice Address - Street 1:5415 SUMMERWOOD DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-8802
Practice Address - Country:US
Practice Address - Phone:254-718-4843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX162758164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse