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.
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)
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
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physician Assistant (363A00000X)