Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Elijah Wagoner

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1699607515

Elijah Wagoner is a Student in an Organized Health Care Education/Training Program in Tulsa, Oklahoma. Practices as a sole proprietor. Licensed in Oklahoma.

Licensed in
OK
In the registry since
2026
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Practice location Address checks out

1111 W 17th St
Tulsa, OK 74107-1800
Phone: (402) 690-6464
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X (OK)

Record details

NPI number1699607515
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJune 3, 2026
Last updated in NPPESJune 3, 2026
Certification dateJune 2, 2026
Mailing address14118 Cedar Cir, Omaha, NE 68144-2120

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