NPIMap

Organization Active NPI

Divinity Wellness Center PLLC

  • Primary Care Clinic/Center
  • Winston Salem, NC
National Provider Identifier
1235845082
Registry record updated Jun 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
DIVINITY WELLNESS CENTER PLLC
Practice address
620 N Dunleith Ave
Winston Salem, NC 27101-3374
Phone
(336) 221-3454
Fax
(336) 245-4601
NPI assigned
Jan 25, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2026

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

Authorized official

Name
Dexteria Rebecca Jenkins, AGNP-CNPI 1790284214
Title
Owner
Phone
(336) 225-1079

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

620 N Dunleith Ave
Winston Salem, NC 27101-3374

Mailing address

PO Box 286
Wallburg, NC 27373-0286
Phone (336) 221-3454

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230518003758 NC Part B Supplier - Clinic/Group Practice 4789040684 Receives reassigned benefits from 2 practitioners
Practice locations: Winston Salem, NC

National Provider Directory

National Provider Directory

Locations

620 N Dunleith Ave
Winston Salem, NC 27101
Phone (336) 278-1318

Practitioners & affiliated clinicians

Practitioners 3

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": "1674604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782172800000",
    "number": "1235845082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 286",
            "city": "WALLBURG",
            "state": "NC",
            "postal_code": "273730286",
            "telephone_number": "336-221-3454",
            "fax_number": "336-245-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 N DUNLEITH AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271013374",
            "telephone_number": "336-221-3454",
            "fax_number": "336-245-4601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINITY WELLNESS CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-25",
        "last_updated": "2026-06-23",
        "certification_date": "2026-06-23",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "DEXTERIA",
        "authorized_official_middle_name": "REBECCA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-225-1079",
        "authorized_official_credential": "AGNP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.