Individual provider Active NPI

Sophie Gwelo, APRN-CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1104419282
Registry record updated Jul 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
1030376 Issued in TX
Practice address
2538 E University Dr Ste 280
Phoenix, AZ 85034-6947
Phone
(214) 335-9784
NPI assigned
Feb 18, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1030376 TX Primary

Addresses

Primary practice location

2538 E University Dr Ste 280
Phoenix, AZ 85034-6947

Mailing address

2538 E University Dr Ste 280
Phoenix, AZ 85034-6947
Phone (214) 335-9784

Other practice location 1

8050 S Pointe Pkwy W Apt 1056
Phoenix, AZ 85044-5419
Phone (214) 335-9784

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210505003167 AZ Practitioner - Nurse Practitioner 7416366331 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1030376TXMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Healing Continually Center LLC CurrentSince Jul 31, 2024 Accepting new patients

Locations

2538 E University Dr
Ste 280
Phoenix, AZ 85034
Phone (214) 335-9784

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720828800000",
    "number": "1104419282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2538 E UNIVERSITY DR STE 280",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850346947",
            "telephone_number": "214-335-9784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2538 E UNIVERSITY DR STE 280",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850346947",
            "telephone_number": "214-335-9784"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8050 S Pointe Pkwy W Apt 1056",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850445419",
            "country_code": "US",
            "telephone_number": "214-335-9784",
            "fax_number": "970-695-7751",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GWELO",
        "first_name": "SOPHIE",
        "credential": "APRN-CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-18",
        "last_updated": "2024-07-13",
        "certification_date": "2024-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1030376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.