Healthcare Provider Details

I. General information

NPI: 1073481123
Provider Name (Legal Business Name): AGAPE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42598 STATE HIGHWAY 75
ALTOONA AL
35952-6566
US

IV. Provider business mailing address

1274 MOUNT CARMEL RD
ALTOONA AL
35952-9111
US

V. Phone/Fax

Practice location:
  • Phone: 205-466-9096
  • Fax:
Mailing address:
  • Phone: 256-298-6768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KASEY H WILSON
Title or Position: OWNER
Credential: CRNP
Phone: 256-298-6768