| Doctor Name: | MRS. PAMELA COY WAGNER |
| NPI Number: | 1992881064 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, FNP |
| License Number: | 2006004567-22 |
| Business Practice Address: | 899 Fm 632 Kenedy, TX - 781194516 |
| Business Phone Number: | 8305834003 |
| Business Fax Number: | |
| Mailing Address: | 1554 Fm 622, VICTORIA |
| State: | TX |
| Postal Code: | 779053106 |
| Phone Number: | 3615765519 |
| Fax Number: | |
| NPI Enumeration Date: | 10/31/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2006004567-22 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |