Healthcare Provider Details

I. General information

NPI: 1154225563
Provider Name (Legal Business Name): MOMENTUM HEALTH AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 N FAYETTEVILLE ST
ASHEBORO NC
27203-3920
US

IV. Provider business mailing address

100 HOMEPLACE DR
RANDLEMAN NC
27317-9600
US

V. Phone/Fax

Practice location:
  • Phone: 336-318-5572
  • Fax:
Mailing address:
  • Phone: 336-318-5572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACQUELINE KING
Title or Position: FNP-C
Credential:
Phone: 336-318-5572