Healthcare Provider Details

I. General information

NPI: 1750244679
Provider Name (Legal Business Name): DRMRHPGWRD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2098 TIGER EYE CT
WINSTON SALEM NC
27127-8009
US

IV. Provider business mailing address

2098 TIGER EYE CT
WINSTON SALEM NC
27127-8009
US

V. Phone/Fax

Practice location:
  • Phone: 619-940-5022
  • Fax: 954-405-8525
Mailing address:
  • Phone: 619-940-5022
  • Fax: 954-405-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MERIAH PAIGE WARD
Title or Position: CEO AND PMHNP-BC
Credential: FNP-BC, PMHNP-BC
Phone: 704-500-1065