Awaken Wellness NC, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

AWAKEN WELLNESS NC, LLC

Practice address

2529 Raeford Rd
Fayetteville, NC 28305-5098

Phone

(910) 644-0588

Fax

(725) 209-1671

NPI assigned

Jul 27, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Tanya Gibbs, FNPNPI 1710445754

Title

Owner/President

Phone

(910) 644-0588

Specialties & licenses 1

Addresses

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23854/brand/1/csg/1/fhir/r4

Practitioners 1

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

• Tanya Gibbs, FNP

  • Family Nurse Practitioner
  • Fayetteville, NC
  • NPI 1710445754
  NPD Authorized official

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

{
    "created_epoch": "1627344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628208000000",
    "number": "1518630599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5964 DALTON RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283141022",
            "telephone_number": "910-973-2689",
            "fax_number": "725-209-1671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2529 RAEFORD RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055098",
            "telephone_number": "910-644-0588",
            "fax_number": "725-209-1671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AWAKEN WELLNESS NC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-27",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A",
        "authorized_official_last_name": "GIBBS",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "910-644-0588",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Averette, LCSW
• Kyasia Avery
• Avid Health at Home North Carolina (Avid Health at Home NC)
• Diana Wilma Avila, LCAS
• Ramatou Awaasah
• Emilia Ayala
• Robert Andrew Ayers, PA-C
• Olivia Joy Ayre
• Abul K Azad, MD
• Khalid Aziz, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; 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.