CMS-1500 Box 24J / 33a • NPI
1962092114
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
363LA2200X (CMS 50)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Adult Health
Box 32 Service Location & ZIP+4
2045 MAYBANK HWY, CHARLESTON, SC, 29412
Official NPPES Practice Location
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1962092114 (ABUNDANT GRACE WELLNESS, LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1962092114 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | ABUNDANT GRACE WELLNESS, LLC |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Adult Health NUCC Code: 363LA2200X (Nurse Practitioner, Adult Health) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 2045 MAYBANK HWY, CHARLESTON, SC, 29412 |
| Practice Telephone / Fax | Tel: (843) 801-0861 | Fax: (843) 768-1473 |
| Administrative Mailing Address | 2414 RACQUET CLUB DRIVE, JOHNS ISLAND, SC, 29455-6300 |
| Enumeration & Last Sync | Enumerated: 2021-01-21 | CMS Record Updated: 2023-09-14 |
| Authorized Official | GLORIA WILSON (Authorized Official/Provider) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
🗺️ Open in Google Maps 🏥 More Providers in CHARLESTON
🔒 Are you ABUNDANT GRACE WELLNESS, LLC? Get your Verified NPI Clinic Badge or request personal phone/address redaction →
Plain-English Taxonomy & CMS Crosswalk (363LA2200X)
What Does Taxonomy Code 363LA2200X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LA2200X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Adult Health"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (ABUNDANT GRACE WELLNESS, LLC)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
363LC1500X — Nurse Practitioner, Community HealthPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Community Health | State: N/A | License: Verified | Primary: Secondary |
363LP0808X — Nurse Practitioner, Psych/Mental HealthPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health | State: N/A | License: Verified | Primary: Secondary |
363LA2200X — Nurse Practitioner, Adult HealthPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Adult Health | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.