National Provider Identifier

Kourtney Lenea Waggoner, PA

Kourtney Lenea Waggoner, PA is listed in the NPPES registry with a primary specialty of Physician Assistant in Kenmore, NY and a listed phone number of (716) 529-3070.

NPI 1265997191Kenmore, NYPhysician Assistant

Source: public NPPES record, last updated February 05, 2019. This profile is informational and is not medical advice, a quality rating, or a provider recommendation.

Profile Overview

NPI
1265997191
Provider Type
Individual
Primary Specialty
Physician Assistant
Enumeration Date
February 05, 2019
Last Updated
February 05, 2019

Practice Location

  • 2950 Elmwood Ave Ste A1
  • Kenmore, NY 14217-1304

Phone: (716) 529-3070

Mailing Address

  • 3719 Union RD Ste 218
  • Cheektowaga, NY 14225-4251

Specialties

  • Physician Assistant (363A00000X)

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Full Record
NPI
1265997191
Entity Type
Individual
Last Name
Waggoner
First Name
Kourtney
Middle Name
Lenea
Credential
PA
Mailing Street Address
3719 Union RD Ste 218
Mailing City
Cheektowaga
Mailing State
NY
Mailing ZIP Code
14225-4251
Mailing Country
US
Mailing Phone
(716) 206-1503
Mailing Fax
(716) 651-9945
Practice Street Address
2950 Elmwood Ave Ste A1
Practice City
Kenmore
Practice State
NY
Practice ZIP Code
14217-1304
Practice Country
US
Practice Phone
(716) 529-3070
Practice Fax
(716) 529-3071
Enumeration Date
February 05, 2019
Last Updated
February 05, 2019
Sex
Female
Sole Proprietor
No
Taxonomies
Physician Assistant (363A00000X)