Provider Demographics
NPI:1891486965
Name:WAGNER, MAKAYLA JO (PA)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:JO
Last Name:WAGNER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:6001 SW 6TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66615-1004
Mailing Address - Country:US
Mailing Address - Phone:852-337-4917
Mailing Address - Fax:
Practice Address - Street 1:6001 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615-1011
Practice Address - Country:US
Practice Address - Phone:852-337-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2024-02-07
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant