Individual provider Active NPI

Racine M Wabwende, APRN PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Loganville, GA
National Provider Identifier
1417897950
Registry record updated Apr 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN-NP713696 Issued in GA
Practice address
367 Baymist Dr
Loganville, GA 30052-9056
Phone
(312) 383-3680
Fax
(312) 383-3680
NPI assigned
Apr 1, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 1, 2026

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 PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X APRN-NP713696 GA Primary

Addresses

Primary practice location

367 Baymist Dr
Loganville, GA 30052-9056

Mailing address

367 Baymist Dr
Loganville, GA 30052-9056
Phone (312) 383-3680

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
APRN-NP713696GAMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1775001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775001600000",
    "number": "1417897950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 BAYMIST DR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300529056",
            "telephone_number": "312-383-3680",
            "fax_number": "312-383-3680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 BAYMIST DR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300529056",
            "telephone_number": "312-383-3680",
            "fax_number": "312-383-3680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WABWENDE",
        "first_name": "RACINE",
        "middle_name": "M",
        "credential": "APRN PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-04-01",
        "last_updated": "2026-04-01",
        "certification_date": "2026-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "APRN-NP713696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loganville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2026; 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.