NPIMap

Organization Active NPI

Step Up Pediatric and Adolescent Wellness Center

  • Pediatrics Physician
  • Winston Salem, NC
National Provider Identifier
1801163423
Registry record updated Apr 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
177279 Issued in NC
Legal business name
STEP UP PEDIATRIC AND ADOLESCENT WELLNESS CENTER
Practice address
3410 Healy Dr
Suite 110
Winston Salem, NC 27103-1403
Phone
(336) 765-8614
Fax
(336) 765-8605
NPI assigned
Nov 28, 2011
Last updated
Apr 26, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2016

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

Authorized official

Name
Leticia Estela Helleby-Hardy, M.D.NPI 1528268851
Title
Director
Phone
(336) 765-8614

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 124938 NC
Professional Counselor 101YP2500X NC
Pediatrics Physician 208000000X 177279 NC Primary

Addresses

Primary practice location

3410 Healy Dr
Suite 110
Winston Salem, NC 27103-1403

Mailing address

PO Box 843
Crozet, VA 22932-0801
Phone (336) 765-8614

Other identifiers 1

IdentifierTypeStateIssuer
026MPOtherBCBS

National Provider Directory

National Provider Directory

Locations

3410 Healy Dr
Ste 110
Winston Salem, NC 27103
Phone (336) 765-8614

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1322438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461628800000",
    "number": "1801163423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 843",
            "city": "CROZET",
            "state": "VA",
            "postal_code": "229320801",
            "telephone_number": "336-765-8614",
            "fax_number": "336-765-8605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3410 HEALY DR",
            "address_2": "SUITE 110",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031403",
            "telephone_number": "336-765-8614",
            "fax_number": "336-765-8605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEP UP PEDIATRIC AND ADOLESCENT WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-28",
        "last_updated": "2016-04-26",
        "status": "A",
        "authorized_official_last_name": "HELLEBY-HARDY",
        "authorized_official_first_name": "LETICIA",
        "authorized_official_middle_name": "ESTELA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "336-765-8614",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "124938",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "177279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "026MP",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2016; 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.