| Doctor Name: | MELISSA DALTON WAGNER |
| NPI Number: | 1174992382 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | F0915844 |
| Business Practice Address: | 822 South Mayo Trail Paintsville, KY - 412401270 |
| Business Phone Number: | 6067895541 |
| Business Fax Number: | 6067899445 |
| Mailing Address: | 822 South Mayo Trail, PAINTSVILLE |
| State: | KY |
| Postal Code: | 412401270 |
| Phone Number: | 6067895541 |
| Fax Number: | 6067899445 |
| NPI Enumeration Date: | 09/17/2015 |
| NPI Last Update Date: | 10/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F0915844 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |