NPIMap

Organization Active NPI

Nurtured Radiance Wellness

  • Occupational Therapist
  • Knightdale, NC
National Provider Identifier
1205659570
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
NURTURED RADIANCE WELLNESS
Practice address
405 Knightdale Station Run
Knightdale, NC 27545-7288
Phone
(845) 665-2888
NPI assigned
Nov 5, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Authorized official

Name
Anastasia GibsonNPI 1053854794
Title
Owner
Phone
(845) 665-2888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225X00000X Primary

Addresses

Primary practice location

405 Knightdale Station Run
Knightdale, NC 27545-7288

Mailing address

42 Chaparral TRL
Garner, NC 27529-6655

National Provider Directory

National Provider Directory

Locations

405 Knightdale Station Run
Knightdale, NC 27545
Phone (845) 665-2888

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1730764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730764800000",
    "number": "1205659570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 CHAPARRAL TRL",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275296655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 KNIGHTDALE STATION RUN",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275457288",
            "telephone_number": "845-665-2888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NURTURED RADIANCE WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-05",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "ANASTASIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "845-665-2888"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knightdale, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.