Abundant Grace Wellness, LLC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Legal business name

ABUNDANT GRACE WELLNESS, LLC

Practice address

2045 Maybank Hwy
Charleston, SC 29412

Phone

(843) 801-0861

Fax

(843) 768-1473

NPI assigned

Jan 21, 2021

Organization subpart

No

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

Authorized official

Name

Gloria Katherine Wilson, APRNNPI 1184034027

Title

Authorized Official/Provider

Phone

(843) 801-0861

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 2

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

• Gloria Katherine Wilson, APRN

  • Nurse Practitioner
  • Charleston, SC
  • NPI 1184034027

  Community Health

  Medicare reassignment NPD Authorized official
• Daphne Jane Timmons, PHD

  • Psychologist
  • Charleston, SC
  • NPI 1326087149
  NPD (past)

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

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694649600000",
    "number": "1962092114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2414 RACQUET CLUB DRIVE",
            "city": "JOHNS ISLAND",
            "state": "SC",
            "postal_code": "294556300",
            "telephone_number": "843-801-0861",
            "fax_number": "843-768-1473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2045 MAYBANK HWY",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29412",
            "telephone_number": "843-801-0861",
            "fax_number": "843-768-1473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABUNDANT GRACE WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-21",
        "last_updated": "2023-09-14",
        "certification_date": "2021-01-21",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_middle_name": "KATHERINE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL/PROVIDER",
        "authorized_official_telephone_number": "843-801-0861",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "18678",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gloriawilson@icloud.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1003 Landfall Way Ste A",
            "city": "Seabrook Island",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294556323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Joseph Anwar Abro, MD
• Sameer Abrol, MD
• Ahmad Abu Qdais, MD
• Tayita Abudu
• Osama Abuhasheesh, MD
• Abx Solutions, LLC
• Maria Bernadette Acabodillo
• Ace Case Manage Services, LLC
• Anand Achanti, MD
• Kathryn Achanti, APRN

• Adult Health Nurse Practitioner in Charleston, SC
• Providers in Charleston, SC by specialty
• Adult Health Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2023; 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.