| Divinity Wellness Center Pllc | |
|
620 N Dunleith Ave Winston Salem NC 27101-3374 | |
| (336) 221-3454 | |
| (336) 245-4601 |
| Full Name | Divinity Wellness Center Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 620 N Dunleith Ave, Winston Salem, North Carolina |
| Authorized Official Name and Position | Dexteria Rebecca Jenkins (OWNER) |
| Authorized Official Contact | 3362251079 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divinity Wellness Center Pllc Po Box 286 Wallburg NC 27373-0286 Ph: (336) 221-3454 | Divinity Wellness Center Pllc 620 N Dunleith Ave Winston Salem NC 27101-3374 Ph: (336) 221-3454 |
| NPI Number | 1235845082 |
|---|---|
| Provider Enumeration Date | 01/25/2023 |
| Last Update Date | 06/23/2026 |
| Medicare PECOS PAC ID | 4789040684 |
|---|---|
| Medicare Enrollment ID | O20230518003758 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235845082 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Tawanna Latice Hairston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194789784 PECOS PAC ID: 2668646373 Enrollment ID: I20111115000369 |
| Provider Name | Cynthia Denise Dalton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568890432 PECOS PAC ID: 0840429403 Enrollment ID: I20140131001689 |
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