Agave Postpartum Wellness Clinic PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

AGAVE POSTPARTUM WELLNESS CLINIC PLLC

Practice address

21725 N 20TH Ave
Suite 101-102 #1019
Phoenix, AZ 85027-2640

Phone

(602) 384-1648

NPI assigned

May 28, 2021

Organization subpart

No

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

Authorized official

Name

Inty Allen, FNP

Title

Owner/Provider

Phone

(602) 384-1648

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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

• Ilka Mayela Moreno, CNP

  • Family Nurse Practitioner
  • Sun City, AZ
  • NPI 1396343430

  Family

  NPD (past)

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

{
    "created_epoch": "1622160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651622400000",
    "number": "1386210508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21725 N 20TH AVE",
            "address_2": "SUITE 101-102 #1019",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850272640",
            "telephone_number": "602-384-1648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21725 N 20TH AVE",
            "address_2": "SUITE 101-102 #1019",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850272640",
            "telephone_number": "602-384-1648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAVE POSTPARTUM WELLNESS CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-28",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "INTY",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "602-384-1648",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Agave Chiropractic, LLC
• Agave Dental LLC
• Agave Foot Specialists, PLLC
• Agave Healthcare LLC
• Agave Physician Services LLC
• Agave Surgery Center
• Agave Therapeutics PLLC
• Agavia LLC
• Charlie M. Agee, M.D.
• Loran Agee

• All providers in Phoenix, AZ
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; 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.