Comprehensive Wellness Center of North Carolina, PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5004371 Issued in NC

Legal business name

COMPREHENSIVE WELLNESS CENTER OF NORTH CAROLINA, PLLC

Practice address

1201 Gum Branch Rd
Jacksonville, NC 28540-5016

Phone

(910) 353-1991

Fax

(910) 455-6698

NPI assigned

Jul 23, 2012

Last updated

Feb 3, 2014By 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

Pauline Frederick, FNP

Title

Family Nurse Practitioner

Phone

(910) 353-1991

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1343001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391385600000",
    "number": "1942555370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 GUM BRANCH RD",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285405016",
            "telephone_number": "910-353-1991",
            "fax_number": "910-455-6698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 GUM BRANCH RD",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285405016",
            "telephone_number": "910-353-1991",
            "fax_number": "910-455-6698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE WELLNESS CENTER OF NORTH CAROLINA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-23",
        "last_updated": "2014-02-03",
        "status": "A",
        "authorized_official_last_name": "FREDERICK",
        "authorized_official_first_name": "PAULINE",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "910-353-1991",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5004371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; 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.