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General NPI Number Information
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NPI Number | 1073481123
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Entity Type | Organization
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Legal Business Name | AGAPE MEDICINE LLC
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Dates
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Enumeration Date | 10/29/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 42598 STATE HIGHWAY 75
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City | ALTOONA
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State | AL
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Zip | 35952-6566
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Country | US
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Telephone | 205-466-9096
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Fax |
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Provider Business Mailing Address
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Address Line | 1274 MOUNT CARMEL RD
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City | ALTOONA
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State | AL
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Zip | 35952-9111
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Country | US
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Telephone | 256-298-6768
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KASEY H WILSON
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Credential | CRNP
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Telephone | 256-298-6768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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