Provider Demographics
NPI:1710437413
Name:WAGGONER, ROYA (APRN)
Entity type:Individual
Prefix:
First Name:ROYA
Middle Name:
Last Name:WAGGONER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ROJA
Other - Middle Name:K
Other - Last Name:TAGHIZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7450 KESSLER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2553
Mailing Address - Country:US
Mailing Address - Phone:913-632-9200
Mailing Address - Fax:913-632-9209
Practice Address - Street 1:7450 KESSLER ST STE 201
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2553
Practice Address - Country:US
Practice Address - Phone:913-632-9200
Practice Address - Fax:913-632-9209
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77422363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner