Diverse Wellness Solutions Inc

Primary specialty

Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0808X

License

0261495-01 Issued in NC

Legal business name

DIVERSE WELLNESS SOLUTIONS INC

Practice address

7155 Sunset Lake Rd
Fuquay Varina, NC 27526-8638

Phone

(919) 838-0804

Fax

(919) 838-1219

NPI assigned

May 6, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Kimball Jane-Marie Sargent, MSN, PMHCNS-BCNPI 1174570808

Title

Owner/President

Phone

(919) 838-0804

Specialties & licenses 3

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 1

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

• Kimball Jane-Marie Sargent, MSN, PMHCNS-BC

  • Adult Psychiatric/Mental Health Clinical Nurse Specialist
  • Fuquay Varina, NC
  • NPI 1174570808

  Multi-Specialty

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1304640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452038400000",
    "number": "1912299173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7155 SUNSET LAKE RD",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275268638",
            "telephone_number": "919-838-0804",
            "fax_number": "919-838-1219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7155 SUNSET LAKE RD",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275268638",
            "telephone_number": "919-838-0804",
            "fax_number": "919-838-1219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSE WELLNESS SOLUTIONS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-06",
        "last_updated": "2016-01-06",
        "status": "A",
        "authorized_official_last_name": "SARGENT",
        "authorized_official_first_name": "KIMBALL",
        "authorized_official_middle_name": "JANE-MARIE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "919-838-0804",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSN, PMHCNS-BC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NC",
            "license": "0261495-01",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NC",
            "license": "0261495-01",
            "primary": false
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "NC",
            "license": "0261495-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NCMC030788",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6004025",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "527619",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "NC1277A203",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "10079",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Edward Devente, M.D.
• Jonathan Dickinson, DPT
• Dignitas Counseling
• Discovery Counseling and Wellness
• Erin Diskin, DDS
• DME Health Solutions LLC
• Jacqueline Doell, LCMHCA
• Meghan Donovan
• Dr. Cameron & Associates of Fuquay, PLLC
• Dr. James P. Honeycutt Jr. DDS, PA

• Psychiatric/Mental Health Clinical Nurse Specialist in Fuquay Varina, NC
• Providers in Fuquay Varina, NC by specialty
• Psychiatric/Mental Health Clinical Nurse Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; 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.