Wagner, Dylan Paul

Wagner, Dylan Paul is an individual health care provider with primary practice located at 2313 Highway 15 N , Laurel MS 39440-1805. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Wagner, Dylan Paul can be contacted via phone (601) 649-2775.

Contact Information

Primary practice address
2313 Highway 15 N Laurel MS 39440-1805
Phone: (601) 649-2775
Fax: (601) 649-2686
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 00172 Mississippi

Profile Details

NPI number 1992058556
LBN Legal business name Wagner, Dylan Paul
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 19th, 2012
Last updated Jul 23rd, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992058556 NPPES
Mississippi Other 5874982 CIGNA
Mississippi MEDICAID 05153323 CIGNA
Mississippi Other 9469937 CIGNA
Mississippi Other 3528936 CIGNA

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