Kourtney Lenea Waggoner, PA

NPI #1265997191 in Kenmore, New York

Provider Information

NPI Number: 1265997191
Entity Type: Individual
Name: Kourtney Lenea Waggoner, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Feb 5, 2019
Last Updated: Feb 5, 2019

Practice Location

Address: 2950 ELMWOOD AVE STE A1
City: Kenmore
State: New York
ZIP Code: 14217-1304
Phone: (716) 529-3070

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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