| Kendall D. Wagner, M.D., PLLC | |
|
500 S University Ave Ste 702 Little Rock AR 72205-5309 | |
| (501) 766-6311 | |
| (472) 227-2345 |
| Full Name | Kendall D. Wagner, M.D., PLLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 500 S University Ave Ste 702, Little Rock, Arkansas |
| Authorized Official Name and Position | Kendall Darren Wagner (PHYSICIAN) |
| Authorized Official Contact | 5017666311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kendall D. Wagner, M.D., PLLC 46 Miramont Cir Little Rock AR 72223-3301 Ph: (501) 766-6311 | Kendall D. Wagner, M.D., PLLC 500 S University Ave Ste 702 Little Rock AR 72205-5309 Ph: (501) 766-6311 |
| NPI Number | 1528721271 |
|---|---|
| Provider Enumeration Date | 10/20/2021 |
| Last Update Date | 09/13/2026 |
| Certification Date | 09/13/2026 |
| Medicare PECOS PAC ID | 5698164283 |
|---|---|
| Medicare Enrollment ID | O20211122000266 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528721271 | NPI | - | NPPES |
| 202855001 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Kendall D Wagner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699091264 PECOS PAC ID: 0244454916 Enrollment ID: I20140619001531 |
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