Divine Family Practice and Urgent Care, PLLC

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

Legal business name

DIVINE FAMILY PRACTICE AND URGENT CARE, PLLC

Practice address

3616 Cape Center Dr
Fayetteville, NC 28304-4456

Phone

(910) 779-0780

Fax

(910) 779-0896

NPI assigned

Nov 5, 2019

Last updated

Aug 30, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Abimbola Ogunleye-Kolawole, DNP, FNP-CNPI 1023294261

Title

President

Phone

(910) 779-0780

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Tax ID family

Divine Family Practice and Urgent Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Divine Family Practice and Urgent Care, PLLC

  • Primary Care Nurse Practitioner
  • Fayetteville, NC
  • NPI 1548881279
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Abimbola A Ogunleye-Kolawole, DNP, FNP-C

  • Family Nurse Practitioner
  • Fayetteville, NC
  • NPI 1023294261
  Medicare reassignment NPD Authorized official
• Patricia E. Chisum, FNP-C

  • Family Nurse Practitioner
  • Jacksonville, NC
  • NPI 1164470266
  Medicare reassignment NPD
• Adetutu Mojisola Sandra Ogunleye, CRNM

  • Advanced Practice Midwife
  • Fayetteville, NC
  • NPI 1720528342
  Medicare reassignment NPD
• Sia Sam-Sumana

  • Family Nurse Practitioner
  • Fayetteville, NC
  • NPI 1740026483
  Medicare reassignment NPD

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

{
    "created_epoch": "1572912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693353600000",
    "number": "1477197168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3616 CAPE CENTER DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044456",
            "telephone_number": "910-779-0780",
            "fax_number": "910-779-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3616 CAPE CENTER DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044456",
            "telephone_number": "910-779-0780",
            "fax_number": "910-779-0896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE FAMILY PRACTICE AND URGENT CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-05",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A",
        "authorized_official_last_name": "OGUNLEYE-KOLAWOLE",
        "authorized_official_first_name": "ABIMBOLA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-779-0780",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP, FNP-C"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Hawkins Ditmore, PHARM D
• Kenneth Dittmar, M. S.
• Diversity Haven LLC (N/a)
• Divine Comfort Transportation LLC
• Divine Doula Goddess Inc
• Divine Family Practice and Urgent Care, PLLC
• Divine Home Care Agency LLC
• Divine Homecare LLC
• Divine Touch Massage Therapy, LLC
• Brenda M. Dixon

• Urgent Care Clinic/Center in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Urgent Care Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; 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.