Mr Clarence Hughes Wagoner Jr, CRNA is a
Nurse Anesthetist, Certified Registered based in Kenansville, North Carolina. Mr Clarence Hughes Wagoner Jr is licensed to practice in North Carolina (license number 059528) and his current practice location is
401 N. Main St., Kenansville, North Carolina. He can be reached at his office (for appointments etc.) via phone at
(910) 296-2608.
NPI number for Mr Clarence Hughes Wagoner Jr is 1235126400 and his current mailing address is Po Box 278, Kenansville, North Carolina. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1235126400.
Provider's Profile
| Full Name | Mr Clarence Hughes Wagoner Jr |
|---|
| Gender | Male |
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| Speciality | Nurse Anesthetist, Certified Registered |
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| Location | 401 N. Main St., Kenansville, North Carolina |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1235126400
- Provider Enumeration Date: 10/04/2005
- Last Update Date: 08/24/2009
Medical Identifiers
Medical identifiers for Mr Clarence Hughes Wagoner Jr such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1235126400 | NPI | - | NPPES |
| 8051164 | Medicaid | NC | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 059528 (North Carolina) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Clarence Hughes Wagoner Jr is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Clarence Hughes Wagoner Jr, CRNA
Po Box 278,
Kenansville, NC 28349-0278
Ph: (910) 296-2608 | Mr Clarence Hughes Wagoner Jr, CRNA
401 N. Main St.,
Kenansville, NC 28349-0278
Ph: (910) 296-2608 |
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