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WAGONER FAMILY HEALTH CLINIC
NPI 1396454484
Nurse Practitioner - Primary Care in Nacogdoches, TX

Active since November 17, 2022CLIA 45D2273779 · Waiver
1023 N MOUND ST STE E, NACOGDOCHES, TX 75961(936) 305-4130(936) 305-4127 Get Directions Write a Review

NPPES record last updated: December 19, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 19, 2022, Nov 17, 2022 (2 updates tracked since 2022).

About Wagoner Family Health Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WAGONER FAMILY HEALTH CLINIC (NPI 1396454484) is a healthcare organization registered as a primary care in Nacogdoches, Texas and active in the NPI registry since November 2022. The organization holds a CLIA Waiver certificate valid through December 18, 2026 and lists Rebekah M Wagoner, Managing Member, as its authorized official.

NPPES Registry Identity

NPI1396454484
Entity TypeOrganization
Primary Taxonomy363LP2300X
Legal Business NameWAGONER HEALTH CLINIC, PLLC
Location Address1023 N MOUND ST STE ENacogdoches, TX 75961-4453
Mailing Address1023 N Mound St Ste ENacogdoches, TX 75961-4453 · (936) 305-4130 · Fax (936) 305-4127
Phone(936) 305-4130
Fax(936) 305-4127
Organization SubpartNo
Authorized OfficialRebekah M WagonerManaging Member · (936) 715-5353
Enumeration DateNovember 17, 2022
Last NPPES UpdateDecember 19, 20222 updates tracked since enumeration
NPPES CertifiedDecember 19, 2022
✔ NPI 1396454484 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP2300X
1023 N MOUND ST STE E, Nacogdoches, TX 75961
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Other Names 1

Doing Business AsWagoner Family Health Clinic

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2273779

Wagoner Health Clinic, PLLC · Nacogdoches, TX
Active · expires Dec 18, 2026
CLIA Number45D2273779
Laboratory TypePractitioner Other
Certificate Effective DateDecember 19, 2024
Certificate Expiration DateDecember 18, 2026
Laboratory DirectorRebekah M. Wagoner
Laboratory Phone(936) 305-4130
Laboratory LocationWagoner Health Clinic, PLLC1023 N Mound Street, Suite E, Nacogdoches, TX 75961
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. JAMES LUCAS WAGONER MSN, APRN, FNP-C
Nurse Practitioner (Family)
1023 N MOUND ST STE E
NACOGDOCHES, TX 75961
Nacogdoches County (936) 305-4130
MRS. REBEKAH MARIE WAGONER APRN, FNP-C
Nurse Practitioner (Family)
1023 N MOUND ST STE E
NACOGDOCHES, TX 75961
Nacogdoches County (936) 305-4130

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wagoner Health Clinic, PLLC's NPI number?

The NPI number for Wagoner Health Clinic, PLLC is 1396454484. It was assigned to this organization in the NPPES registry on November 17, 2022. The provider is doing business as Wagoner Family Health Clinic.

Where is Wagoner Health Clinic, PLLC located?

Wagoner Health Clinic, PLLC is located at 1023 N Mound St Ste E, Nacogdoches, TX 75961. The listed phone number is (936) 305-4130.

What is Wagoner Health Clinic, PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Does Wagoner Health Clinic, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2273779) is associated with this NPI, valid through December 18, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Wagoner Health Clinic, PLLC was last updated on December 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.