# ABUNDANT GRACE WELLNESS, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962092114
- **Authorized official:** GLORIA KATHERINE WILSON APRN (AUTHORIZED OFFICIAL/PROVIDER)
- **Authorized official phone:** (843) 801-0861

## Contact information

- **Practice address:** 2045 MAYBANK HWY, CHARLESTON, SC 29412
- **Practice address phone:** (843) 801-0861
- **Practice address fax:** (843) 768-1473
- **Mailing address:** 2414 RACQUET CLUB DRIVE, JOHNS ISLAND, SC 29455-6300
- **Mailing address phone:** (843) 801-0861
- **Mailing address fax:** (843) 768-1473

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |
| 363LC1500X | Community Health Nurse Practitioner | — | NULL | — |
| 363LC1500X | Community Health Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/21/2021
- **Last updated:** 09/14/2023