MR. BEAU TIMOTHY WAKEFIELD (NPI# 1154942035) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154942035 |
| Entity Type | Individual |
| Full Name | MR. BEAU TIMOTHY WAKEFIELD |
| Credential | NP-C |
| Practice Address |
5104 Reagan Dr Ste 3 Charlotte NC 28206-1392 |
| Practice Telephone | 7044121931 |
| Practice Fax Number | 7045946742 |
| Mailing Telephone | 7044121931 |
| Mailing Fax Number | 7045946742 |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2020-05-01 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
5013067 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
5104 REAGAN DR STE 3 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28206-1392 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275716797 | Mdfamily Medical Group | Pediatrics | 5104 Reagan Dr Ste 3, Charlotte, NC 28206-1392 | 2007-12-06 |
| 1194346924 | Sugar Creek Medical Center, Pllc | Clinic/Center | 5104 Reagan Dr Ste 3, Charlotte, NC 28206-1392 | 2020-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861019150 | Novant Medical Group, Inc. | Family Medicine | 2701 Statesville Ave., Charlotte, NC 28206 | 2020-07-02 |
| 1609433291 | Life Interrupted Counseling Services | Counselor | 4045 N Tryon St Ste A, Charlotte, NC 28206 | 2019-05-20 |
| 1295141216 | Taqiyah Camyah Barber | Prosthetic/Orthotic Supplier | 3829 Perennial Terrace Dr, #g, Charlotte, NC 28206 | 2014-07-10 |
| 1386976033 | Olugboyega Remi Fisher | Community Health Worker | 1801 N.tryon Street, Suiteb114, Charlotte, NC 28206 | 2010-02-05 |
| 1821225699 | Alzenia Kelly Morris | Counselor | 1801 N Tryon Street Ste 339, Charlotte, NC 28206 | 2009-06-18 |
| 1942479936 | American Current Care of North Carolina PC | Clinic/Center | 2835 Jeff Adams Drive, Suite A, Charlotte, NC 28206 | 2008-02-25 |
| 1992823629 | Shari J Baum | Preventive Medicine | 2830 North I-85, Suite A and B, Charlotte, NC 28206 | 2007-03-27 |
| 1255479135 | Tameka Denise Jenkins | Counselor | 1600 Norris Ave., Charlotte, NC 28206 | 2007-02-02 |
| 1871655803 | Dwight Hollier | Counselor | 1801 North Tryon Street, Suite 309, Charlotte, NC 28206 | 2006-12-15 |
| 1093213621 | Mishelle L Lockerby | Counselor | 5108 Reagan Dr, Charlotte, NC 28206 | 2018-01-29 |
| Find all providers in zip 28206 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900268 | Jennifer Marie Wolfe | Nurse Practitioner | 831 E Morehead St Ste 900, Charlotte, NC 28202-2726 | 2020-10-19 |
| 1992312433 | Jean L. Caroline Clippard | Nurse Practitioner | 7149 Wessynton Dr, Charlotte, NC 28226-7548 | 2020-09-29 |
| 1790393676 | Alana Weldon | Nurse Practitioner | 10042 Park Cedar Dr, Charlotte, NC 28210-8916 | 2020-07-16 |
| 1114541455 | Kendra Jackson | Nurse Practitioner | 2809 Coltsgate Rd Ste 100, Charlotte, NC 28211-5583 | 2020-06-02 |
| 1740809599 | Nina Cherry Arnold | Nurse Practitioner | 8914 Cotton Press Rd, Charlotte, NC 28277-6676 | 2020-04-13 |
| 1619509197 | Clinica San Antonio Pllc | Nurse Practitioner | 416 Mccullough Dr Ste 110, Charlotte, NC 28262-4387 | 2020-02-12 |
| 1720626773 | Grace Barrosa Genetiano | Nurse Practitioner | 2503 Roswell Ave Unit 507, Charlotte, NC 28209-1685 | 2019-12-19 |
| 1376181081 | Crystal Delgado Calayag Frantilla | Nurse Practitioner | 4206 Craig Ave, Charlotte, NC 28211-3110 | 2019-12-12 |
| 1962059428 | Jerome Virgil Whitlow II | Nurse Practitioner | 6523 Dillard Ridge Dr, Charlotte, NC 28216-8845 | 2019-08-20 |
| 1053978213 | Katie Lynn Sass | Nurse Practitioner | 7004 Smith Corners Blvd Ste A, Charlotte, NC 28269-3827 | 2019-05-23 |
| Find all providers in CHARLOTTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.