Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1184011074 Individual Practitioner Female Practitioner

Dr. Jacquelynn Wagoner , DO

Pediatrics • Fresno, CA

Professional Overview & Biography Verified Profile Summary

Dr. Jacquelynn Wagoner, DO is a registered healthcare professional specializing in Pediatrics in Fresno, CA. Practice services are available at 2823 FRESNO ST under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

2823 Fresno St

Fresno, CA 937211324

Telephone 5594996556
Associated Practice Facility / Clinic
🏢 Perinatal Medical Group Facility NPI 1760441844

Specialty Benchmarks & Practice Insights

Comparative analytics for Pediatrics in Fresno, CA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 18.0 Yrs
State Avg: 22.5 Yrs
Regional Practice Density
163 Specialists

Practicing in Fresno, CA (9612 Statewide)

Telehealth Adoption Rate
0.6% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2020-01-10
Pediatrics Primary Specialty

NUCC Taxonomy Code: 208000000X

State License CA 20A15405

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Dr. Jonathan Aicardi , DO

Student in an Organized Health Care Education/Training Program

NPI 1073072955

Doctor of Osteopathic Medicine (D.O.)

Shireen Khan

Student in an Organized Health Care Education/Training Program

NPI 1114787769
Dr. Mini Gantla , MD

Student in an Organized Health Care Education/Training Program

NPI 1114869740

Doctor of Medicine (M.D.)

Dr. Ryan Dao , MD, MPH

Student in an Organized Health Care Education/Training Program

NPI 1134921968

Doctor of Medicine (M.D.), Master of Public Health

Hakim Kebir

Pediatrics

NPI 1144677675
NPI 1164531992

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

10 Historical Events
📍
Updated Practice Location October 29, 2018

Registered at 2823 FRESNO ST, FRESNO, CA 937211324 (Tel: 5594596000)

📍
Updated Business Mailing Address October 29, 2018

Registered at 2625 E DIVISADERO ST, FRESNO, CA 937211431 (Tel: 5594432682)

👤
Provider Name / Credentials Updated October 29, 2018

Recorded as JACQUELYNN WAGONER, DO

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 29, 2018

Pediatrics (License #20A15405 in CA)

NPI Profile Active April 19, 2015

NPI status registered as active in NPPES database

📍
Updated Practice Location April 19, 2015

Registered at 155 N FRESNO ST, FRESNO, CA 937012302 (Tel: 5593535141)

📍
Updated Business Mailing Address April 19, 2015

Registered at 155 N FRESNO ST, FRESNO, CA 937012302

👤
Provider Name / Credentials Updated April 19, 2015

Recorded as JACQUELYNN CRUMPACKER, DO

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 19, 2015

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration April 19, 2015

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1184011074
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 19, 2015
Last Update: January 10, 2020
Sole Proprietor: No

Mailing Address

2625 E Divisadero St

Fresno, CA 937211431

Phone: 5594432682

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.