Provider Demographics
NPI:1942598669
Name:WAGNER, RACHEL L (ARNP)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:L
Last Name:WAGNER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:740 COOL SPRINGS BLVD
Practice Address - Street 2:STE 210
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6448
Practice Address - Country:US
Practice Address - Phone:615-771-8786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00128413163W00000X
TNRN0000156341163W00000X
TNANP0000012092363LA2200X
WAAP30005960363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6042891OtherBCBS TN
TN1525718Medicaid
TN1525718Medicaid