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WAGONER PRIMARY CARE, LLC
NPI 1811578701
Nurse Practitioner - Family in Evening Shade, AR

Active since April 21, 2021
1477 HIGHWAY 167, EVENING SHADE, AR 72532(870) 283-2554 Get Directions Write a Review

NPPES record last updated: April 21, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Wagoner Primary Care, Llc NPPES

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

WAGONER PRIMARY CARE, LLC (NPI 1811578701) is a healthcare organization registered as a family in Evening Shade, Arkansas and active in the NPI registry since April 2021. The organization lists Stephanie Leann Wagoner, President, as its authorized official.

NPPES Registry Identity

NPI1811578701
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameWAGONER PRIMARY CARE, LLC
Location Address1477 HIGHWAY 167Evening Shade, AR 72532-9497
Mailing Address1477 Highway 167Evening Shade, AR 72532-9497 · (870) 283-2554
Phone(870) 283-2554
Organization SubpartNo
Authorized OfficialStephanie Leann WagonerPresident · (870) 283-2554
Enumeration DateApril 21, 2021
NPPES CertifiedApril 21, 2021
✔ NPI 1811578701 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
1477 HIGHWAY 167, Evening Shade, AR 72532
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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

Other Providers at the Same Location NPPES

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

STEPHANIE L WAGONER APRN
Nurse Practitioner (Family)
1477 HIGHWAY 167
EVENING SHADE, AR 72532
Sharp County (870) 283-2554

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 Primary Care, LLC's NPI number?

The NPI number for Wagoner Primary Care, LLC is 1811578701. It was assigned to this organization in the NPPES registry on April 21, 2021.

Where is Wagoner Primary Care, LLC located?

Wagoner Primary Care, LLC is located at 1477 Highway 167, Evening Shade, AR 72532. The listed phone number is (870) 283-2554.

What is Wagoner Primary Care, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Wagoner Primary Care, LLC was last updated on April 21, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.