Organization · NPI-2

Abundant Grace Wellness, LLC

Nurse Practitioner, Adult Health · Charleston, SC

NPI number1962092114

StatusActive

Last updated in NPPESSep 14, 2023

Details

NPI: 1962092114
Entity type: Organization (NPI-2)
Legal business name: Abundant Grace Wellness, LLC
Organization subpart: No
Enumeration date: Jan 21, 2021
Certification date: Jan 21, 2021
Last updated: Sep 14, 2023

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363LA2200X	Nurse Practitioner, Adult Health	–	–	Yes
363LC1500X	Nurse Practitioner, Community Health	–	–
363LP0808X	Nurse Practitioner, Psych/Mental Health	–	–

Practice location

2045 Maybank Hwy
Charleston, SC 29412

Phone 843-801-0861 · Fax 843-768-1473

Mailing address

2414 Racquet Club Drive
Johns Island, SC 29455-6300

Phone 843-801-0861 · Fax 843-768-1473

Authorized official

Gloria Katherine Wilson
Authorized Official/Provider
8438010861

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