Fort Mill Senior Wellness LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

FORT MILL SENIOR WELLNESS LLC

Practice address

331 E Main St Ste 200
Rock Hill, SC 29730-5384

Phone

(704) 438-0687

Fax

(844) 591-0104

NPI assigned

Apr 8, 2024

Organization subpart

No

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

Authorized official

Name

Kelli P Gagne, APRNNPI 1861775264

Title

President

Phone

(860) 346-0252

Specialties & licenses 4

Addresses

Other names 1

• Self Employed Former legal business name

Practitioners 1

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

• Kelli P Gagne, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Rock Hill, SC
  • NPI 1861775264
  NPD Authorized official

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

{
    "created_epoch": "1712534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712534400000",
    "number": "1336992601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 E MAIN ST STE 200",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297305384",
            "telephone_number": "860-346-0252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 E MAIN ST STE 200",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297305384",
            "telephone_number": "704-438-0687",
            "fax_number": "844-591-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT MILL SENIOR WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-08",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-01",
        "status": "A",
        "authorized_official_last_name": "GAGNE",
        "authorized_official_first_name": "KELLI",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-346-0252",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Self Employed",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Aziyah Armauni Ford
• Caprice Ford
• Olivia Forrest
• Douglas J. Forrester, M.D.
• Anamaria Forsythe, LMSW
• Christie A Forte, MS CCC/SLP
• Roger E Foster II, PHARM D
• Kent Foundos
• Mark Wayne Foust, O.D.
• Derrick Fowler

• Nurse Practitioner in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.