Individual provider Active NPI

Gwendolyn Flowers Revels, HIS

  • Hearing Instrument Specialist
  • Williamston, NC
National Provider Identifier
1740089309
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hearing Instrument SpecialistTaxonomy code 237700000X
License
1698 Issued in NC
Practice address
603 E Boulevard Ste B
Williamston, NC 27892-2781
Phone
(252) 789-4008
NPI assigned
Mar 7, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hearing Instrument Specialist 237700000X 1698 NC Primary

Addresses

Primary practice location

603 E Boulevard Ste B
Williamston, NC 27892-2781

Mailing address

603 E Boulevard Ste B
Williamston, NC 27892-2781
Phone (252) 789-4008

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
1698NCMDHearing Instrument Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Audiology Services Company USA, LLC PastSince Mar 11, 2025 Accepting new patients
Audiology Services Company USA, LLC Hearing Instrument Specialist PastSince Mar 11, 2025 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1741305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1740089309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 E BOULEVARD STE B",
            "city": "WILLIAMSTON",
            "state": "NC",
            "postal_code": "278922781",
            "telephone_number": "252-789-4008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 E BOULEVARD STE B",
            "city": "WILLIAMSTON",
            "state": "NC",
            "postal_code": "278922781",
            "telephone_number": "252-789-4008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVELS",
        "first_name": "GWENDOLYN",
        "middle_name": "FLOWERS",
        "credential": "HIS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-07",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "NC",
            "license": "1698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamston, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2025; 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.