Providence Pediatric Functional Medicine, PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PROVIDENCE PEDIATRIC FUNCTIONAL MEDICINE, PLLC

Practice address

610 N Fayetteville St Ste 102
Asheboro, NC 27203-4671

Phone

(336) 233-7882

NPI assigned

Jun 3, 2026

Last updated

Sep 18, 2026By 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

Nicole Anderson, CPNP-PCNPI 1235668419

Title

Owner/Authorized Offician

Phone

(743) 224-7137

Specialties & licenses 2

Addresses

Practitioners 1

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.

• Nicole Thompson Anderson, CPNP-PC

  • Pediatric Nurse Practitioner
  • Asheboro, NC
  • NPI 1235668419

  Pediatrics

  NPD Authorized official

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

{
    "created_epoch": "1780444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789689600000",
    "number": "1710810437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 N FAYETTEVILLE ST STE 102",
            "city": "ASHEBORO",
            "state": "NC",
            "postal_code": "272034671",
            "telephone_number": "743-224-7137",
            "fax_number": "336-290-5084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N FAYETTEVILLE ST STE 102",
            "city": "ASHEBORO",
            "state": "NC",
            "postal_code": "272034671",
            "telephone_number": "336-233-7882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PEDIATRIC FUNCTIONAL MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-06-03",
        "last_updated": "2026-09-18",
        "certification_date": "2026-09-18",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER/AUTHORIZED OFFICIAN",
        "authorized_official_telephone_number": "743-224-7137",
        "authorized_official_credential": "CPNP-PC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Program Resource Institute, Inc.
• Program Resource Institute, Inc.
• Program Resource Institute, Inc.
• Propt, LLC
• Providence Counseling and Wellness, PLLC
• Etta Marie Pruitt, COTA/L
• Mary Beth Pugh, M.S.W., L.C.S.W.
• Devonna Purnell
• Quantum Health Group, P.a.
• Tamea Lyndesha Quick

• Primary Care Clinic/Center in Asheboro, NC
• Providers in Asheboro, NC by specialty
• Primary Care Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.