| Kayla Rose Wagner, RD, LD | |
|
712 S Cascade St, Fergus Falls, MN 56537-2913 | |
| (218) 736-8000 | |
| (218) 736-8719 |
| Full Name | Kayla Rose Wagner |
|---|---|
| Gender | Female |
| Speciality | Dietitian, Registered |
| Location | 712 S Cascade St, Fergus Falls, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235492570 | NPI | - | NPPES |
| 10050503 | Other | MN | SERVSAFE |
| 3119 | Other | MN | BOARD OF DIETETICS & NUTRITION PRACTICE |
| XE20265137 | Other | NATIONAL REGISTRY OF FOOD SAFETY CERTIFIED FOOD SAFETY MANAGER | |
| 86007314 | Other | MN | ACADEMY OF NUTRITION AND DIETETICS VERIFICATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 133V00000X | Dietitian, Registered | 3119 (Minnesota) | Primary |
| Provider Name | Prairie Ridge Hospital And Health Services |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1407838329 PECOS PAC ID: 0648222349 Enrollment ID: O20050210000490 |
| Provider Name | Lake Region Healthcare Corporation |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1093713372 PECOS PAC ID: 3971565334 Enrollment ID: O20060109000246 |
| Mailing Address | Practice Location Address |
|---|---|
| Kayla Rose Wagner, RD, LD 712 S Cascade St, Fergus Falls, MN 56537-2913 Ph: (218) 736-8000 | Kayla Rose Wagner, RD, LD 712 S Cascade St, Fergus Falls, MN 56537-2913 Ph: (218) 736-8000 |
Julie Hamre, RD LD Dietitian Medicare: Medicare Enrolled Practice Location: 712 S Cascade St, Fergus Falls, MN 56537 Phone: 218-736-8000 Fax: 218-736-8765 | |
Miss Josephine Anne Kugler, MS, RD, LD Dietitian Medicare: Medicare Enrolled Practice Location: 712 S Cascade St, Fergus Falls, MN 56537 Phone: 218-736-8059 Fax: 218-736-8727 | |
Emily Dirkes, RD Dietitian Medicare: Medicare Enrolled Practice Location: 712 S Cascade St, Fergus Falls, MN 56537 Phone: 218-736-8059 | |
Mary Hagstrom, RD, LD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 712 Cascade St S, Fergus Falls, MN 56537 Phone: 218-736-8059 | |
Kristy Norenberg, MPH, RD Dietitian Medicare: Medicare Enrolled Practice Location: 712 S Cascade St, Fergus Falls, MN 56537 Phone: 218-736-8059 Fax: 218-736-8727 | |
Katrina Lea Mouser, RD, LD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 25212 County Highway 124, Fergus Falls, MN 56537 Phone: 218-770-9788 |