Awaken by Wellness LLC

Primary specialty

Community Health Clinic/CenterTaxonomy code 261QC1500X

Legal business name

AWAKEN BY WELLNESS LLC

Doing business as

Aga Young

Practice address

606 North Utica Street
Terry, MS 39170

Phone

(228) 213-7972

NPI assigned

Dec 9, 2024

Last updated

Dec 9, 2024By 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

Aga Daneen Young, LIFESTYLE/WELLNESSNPI 1790491355

Title

Practitioner

Phone

(228) 213-7972

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• Aga Young Doing business as

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.

• Aga Daneen Young, PHYSICIAN ASSISTANT

  • Public Health & General Preventive Medicine Physician
  • Terry, MS
  • NPI 1790491355
  NPD Authorized official

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

{
    "created_epoch": "1733702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733702400000",
    "number": "1952117533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 NORTH UTICA STREET",
            "city": "TERRY",
            "state": "MS",
            "postal_code": "39170",
            "telephone_number": "228-213-7972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 NORTH UTICA STREET",
            "city": "TERRY",
            "state": "MS",
            "postal_code": "39170",
            "telephone_number": "228-213-7972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AWAKEN BY WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-09",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-08",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "AGA",
        "authorized_official_middle_name": "DANEEN",
        "authorized_official_title_or_position": "PRACTITIONER",
        "authorized_official_telephone_number": "228-213-7972",
        "authorized_official_credential": "LIFESTYLE/WELLNESS"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790491355",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aga Young",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Above Average Healthcare
• Marisa Nicole Barlow, FNP
• Darius Campbell
• Caring Hearts of Mississippi Nonprofit Outreach
• Central Mississippi Civic Improvement Association, Inc. (Jackson-Hinds Comprehensive Health Center Byram Middle School-based Cl)
• Central Mississippi Civic Improvement Association, Inc. (Jackson-Hinds Comprehensive Health Center - Terry High School-based Cl)

• Community Health Clinic/Center in Terry, MS
• Providers in Terry, MS by specialty
• Community Health Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2024; 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.