| NPI | 1801866512 |
|---|---|
| Professional Name | KYMBER TRACY VAN WAGONER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: UT 03081433102) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2007-07-08 |