Etteilla Wellness Services PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ETTEILLA WELLNESS SERVICES PLLC

Practice address

200 Cedarpost Dr
Cary, NC 27513-8316

Phone

(576) 476-2775

NPI assigned

Apr 1, 2021

Organization subpart

No

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

Authorized official

Name

Shirley McDowell

Title

Owner

Phone

(516) 476-2775

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

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

{
    "created_epoch": "1617235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617235200000",
    "number": "1528646262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CEDARPOST DR",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275138316",
            "telephone_number": "576-476-2775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CEDARPOST DR",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275138316",
            "telephone_number": "576-476-2775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETTEILLA WELLNESS SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-01",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A",
        "authorized_official_last_name": "MCDOWELL",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-476-2775"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaylen Marissa Etheridge
• Mary Anne Etheridge, PH.D.
• Roy L Etheridge, PH.D.
• Gretchen Ethridge
• Jamie B Etringer, RBT
• Eunoia Counseling, PLLC
• Dawn Priscilla Evancho, PA-C
• Bradley H Evans, MD
• Jessica Sarah Evans
• Joanna Patricia Evans, LCSW

• Family Medicine Physician in Cary, NC
• Providers in Cary, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2021; 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.